Pulmonary Blood Flow Measurements in CHF Patients
| Status: | Terminated |
|---|---|
| Conditions: | Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 50 - Any |
| Updated: | 4/21/2016 |
| Start Date: | September 2012 |
| End Date: | April 2015 |
Evaluation of Pulmonary Blood Flow Patterns Using Transthoracic Doppler in Patients With Congestive Heart Failure
Historically, transthoracic Doppler echocardiography has been unable to provide
interpretable data of blood flow within the lung parenchyma because of air attenuation of
Doppler signals. Recently, a transthoracic Doppler system known as the Sonara/tek
Transcranial Doppler (TCD) System has been developed that can identify parenchymal pulmonary
blood flow (PPBF) signals. The ability to non-invasively collect information regarding the
pulmonary aspect of the cardio-pulmonary system may provide valuable information and new
insights into the structural and functional characteristics of the lung parenchyma and
vasculature in health and disease states.
interpretable data of blood flow within the lung parenchyma because of air attenuation of
Doppler signals. Recently, a transthoracic Doppler system known as the Sonara/tek
Transcranial Doppler (TCD) System has been developed that can identify parenchymal pulmonary
blood flow (PPBF) signals. The ability to non-invasively collect information regarding the
pulmonary aspect of the cardio-pulmonary system may provide valuable information and new
insights into the structural and functional characteristics of the lung parenchyma and
vasculature in health and disease states.
This new system was previously studied among 31 healthy volunteers and one subject with
atrial fibrillation.1 Pulsed spectral Doppler signals were obtained over the chest wall
using a signal processing and algorithm package in conjunction with a non-imaging Doppler
device coupled with an electrocardiogram. Clear reproducible lung Doppler signals (LDS)
originating from different elements and phases of cardiac activity that generate mechanical
waves which propagate throughout the lung were expressed in pulsatile changes in ultrasound
reflections.
After the completion of the first 25 patients in our pilot study, we have received some
valuable information. After assessing patients with CHF and pulmonary hypertension, we
identified signals particular to the CHF group. There were unique features that were never
observed in the normal patients. On top of the regular Lung Doppler signals seen in normal
patients, high velocity "disorganized" variable signals that were not synchronous with the
heart beat, but rather sometimes with respiration were observed. We believe that the signals
may represent popping open of small bronchi surrounded by "water filled" parenchyma. These
events that generate very strong reflector like signals may represent the movement of fluid
at the blood vessel-alveolar air junction.
atrial fibrillation.1 Pulsed spectral Doppler signals were obtained over the chest wall
using a signal processing and algorithm package in conjunction with a non-imaging Doppler
device coupled with an electrocardiogram. Clear reproducible lung Doppler signals (LDS)
originating from different elements and phases of cardiac activity that generate mechanical
waves which propagate throughout the lung were expressed in pulsatile changes in ultrasound
reflections.
After the completion of the first 25 patients in our pilot study, we have received some
valuable information. After assessing patients with CHF and pulmonary hypertension, we
identified signals particular to the CHF group. There were unique features that were never
observed in the normal patients. On top of the regular Lung Doppler signals seen in normal
patients, high velocity "disorganized" variable signals that were not synchronous with the
heart beat, but rather sometimes with respiration were observed. We believe that the signals
may represent popping open of small bronchi surrounded by "water filled" parenchyma. These
events that generate very strong reflector like signals may represent the movement of fluid
at the blood vessel-alveolar air junction.
Inclusion Criteria:
- Inclusion criteria
1. Age over 50 years
2. Belongs to one of the following categories:
A. Decompensated CHF: patients with overt pulmonary congestion or pulmonary
edema on admission, evident both clinically and by chest x-ray. Patients may be
with or without a Swan-Ganz catheter.
B. Compensated CHF: patients with significant CHF (NYHA II-IV) who are well
controlled and without evidence of pulmonary congestion or pulmonary edema on
admission.
C. Non-CHF controls: patients without CHF and without any of the following:
pulmonary hypertension, any known pulmonary disease, uncontrolled hypertension.
3. Signed Informed Consent
Exclusion Criteria:
- Chronic obstructive pulmonary disease (COPD) Asthma Interstitial lung disease Any
other obstructive or restrictive lung diseases Pneumonia- currently or in the past 3
months prior to inclusion Current or past pulmonary embolism Non-cardiogenic
pulmonary edema or lung injury (e.g. ARDS) Right sided pleural effusion that is not
mild Severe kyphosis, scoliosis or chest wall deformity
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