Study On Correlations Between Lung Ultrasound And Volume Status And Left Ventricular Diastolic Function

Objective:Lung ultrasound examination because of its safety,convenience,and dynamically monitoring the progress of the disease and outcome,has been applied to clinical in recent years.B-lines recorded by lung ultrasound reflect the changes of extravascular lung water.Maintenance hemodialysis patients often exist different degree of volume overload,and different degree of left ventricular diastolic dysfunction,all can cause the increase of extravascular lung water.Hence,our study was aimed to discuss the correlation between the numbers and changes of B-lines and volume changes and left ventricular diastolic function,and clarify their usefulness in the assessment of volume status during hemodialysis.Methods:Between July 2016 and February 2017,we included those patients in this study whom are undergoing chronic HD treatment for at least 6 months in the dialysis unit from Dalian Municipal Central Hospital.All patients were not hospitalized patients.The general information of patients were collected.The GE LOGIQ 7 ultrasound machine was used to record the B-lines number.Total number of B-lines from lung ultrasound scanning were measured before and after HD treatment,then we calculated the changes of B-lines and weight loss after HD treatment.Also we used echocardiographic to measure the related parameters of left heart function.We used SPSS17.0 statistical software for statistical analysis.Variables are presented as mean ± SD.Differences in variables before and after dialysis were analyzed using the Student t test;The relationships between the various parameters were evaluated using analysis of linear regression.A p-value<0.05 was considered statistically significant.Results:1.we included 31 patients in this study.Before dialysis,17 patients have mild pulmonary congestion(total B-lines 6-15),10 patients have moderate pulmonary congestion(total B-lines 16-30),and 2 patients have severe pulmonary congestion(total B-lines>30).Patients with less than five B-lines is considered to be have no pulmonary congestion.After four-hours dialysis,all patients were losing weight from 71.2±16.4Kg to 68.5±16Kg,and we observed a statistically significant reduction in the total number of B-lines(from14.5±8.0 to 4±3.8).Post-HD 20 patients had no pulmonary congestion,11 patients had mild degree,and no patient had moderate or severe pulmonary congestion.We select E/e' as evaluation index of left ventricular diastolic function,diastolic function was normal or mildly abnormal in8/31,moderately abnormal in 20/31 and severely abnormal in 3/31.Left ventricular ejection fraction was normal in all of the patients.Left ventricular ejection fraction(LVEF)ranged between 33% and 75%,and was normal(>50%)in 29/31 patients.2.No significant results were found calculating linear regression between B-lines reduction versus weight loss during dialysis;but if we exclude those who had a normal left ventricular diastolic function and patients with grade I left ventricular diastolic function(E/e ? < 8)or grade III left ventricular diastolic function(E/e?<15),there was a significant linear regression between B-lines reduction versus weight loss during dialysis among the residual patients.3.Significant results for linear regression were obtained as follows:Number of B-lines before dialysis versus weight gain with respect to dry weight(p=0.026),number of B-lines after dialysis versus E/e' and residual weight.Conclusion:Lung ultrasound of B-lines widely exist in maintenance hemodialysis patients.After HD treatment,B-lines number can be significantly reduced.Weight gain and left ventricular diastolic function will affect the dialysis patients' B-lines degree.The weight gain has a greater effect on the number of B lines before dialysis,while the left ventricular diastolic function has a greater effect on the number of B lines after dialysis.When the degree of left ventricular diastolic dysfunction is not serious,there was a significant linear regression between B-lines reduction versus weight loss during dialysis.These premises make B-lines a promising simple biomarker that could help in the management of volume balance of MHD patients.