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Published in: Cardiovascular Ultrasound 1/2006

Open Access 01-08-2006 | Research

Evaluation of ultrasound lung comets by hand-held echocardiography

Authors: G Bedetti, L Gargani, A Corbisiero, F Frassi, E Poggianti, G Mottola

Published in: Cardiovascular Ultrasound | Issue 1/2006

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Abstract

Background

Ultrasound lung comets (ULCs) are a clinically useful sign of extravascular lung water. They require very limited technology (2 D-echo), and a short learning curve.
The aim of the present study is to compare ULCs information obtained by experienced echocardiologists using a full feature echocardiographic platform and by inexperienced sonographers using a hand-held echocardiography system.

Methods

20 consecutive in-hospital patients underwent, within 15' and in random order, 2 ultrasound examinations for ULCs by 2 observers with different specific expertise and different technology: 1) "high-tech veteran": ULCs assessment with full feature echocardiographic platform (HP Sonos 7500 Philips Medical Systems, Andover, MA, USA) by a trained echocardiologist, with ≥2 years expertise in ULCs assessment and accredited by the European Association of Echocardiography; 2) and a "low-tech beginner": ULCs assessment with hand-held echocardiography (Optigo; Philips, Andover, MA) by an echocardiographer with very limited (30') dedicated training on ULCs assessment.
In each patient, ULC score was obtained by summing the number of comets from each of the scanning spaces in the anterior right and left hemithorax, from the second to the fifth intercostal space.

Results

There was a significant, tight correlation (r = .958, p < 0.001) between the 2 observations in the same patient by "high-tech veteran" and "low-tech beginner".

Conclusion

ULCs are equally reliable in the hands of highly experienced echocardiologists using full feature echocardiographic platforms and in the hands of absolute beginners with miniaturized, compact, and battery-equipped echocardiographic systems. From the technological and expertise viewpoint, ULCs are the "kindergarten" of echocardiography, ideally suited for bedside evaluation of patients with both known or suspected heart failure.
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Literature
1.
go back to reference Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Levy S, Linde C, Lopez-Sendon JL, Nieminen MS, Pierard L, Remme WJ: Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J. 2005, 26: 1115-1140. 10.1093/eurheartj/ehi166CrossRefPubMed Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Levy S, Linde C, Lopez-Sendon JL, Nieminen MS, Pierard L, Remme WJ: Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J. 2005, 26: 1115-1140. 10.1093/eurheartj/ehi166CrossRefPubMed
2.
go back to reference Halperin B, Feeley T, Mihm F, et al.: Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest. 1985, 88: 649-652.CrossRefPubMed Halperin B, Feeley T, Mihm F, et al.: Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest. 1985, 88: 649-652.CrossRefPubMed
3.
go back to reference Eisenberg PR, Hansbrough JR, Anderson D, et al.: A prospective study of lung water measurements during patient management in an intensive care unit. Am Rev Respir Dis. 1987, 136: 662-668.CrossRefPubMed Eisenberg PR, Hansbrough JR, Anderson D, et al.: A prospective study of lung water measurements during patient management in an intensive care unit. Am Rev Respir Dis. 1987, 136: 662-668.CrossRefPubMed
4.
go back to reference Targhetta R, Chavagneaux R, Bourgeois JM, et al.: Sonographic approach to diagnosing pulmonary consolidation. J Ultrasound Med. 1992, 11: 667-672.PubMed Targhetta R, Chavagneaux R, Bourgeois JM, et al.: Sonographic approach to diagnosing pulmonary consolidation. J Ultrasound Med. 1992, 11: 667-672.PubMed
5.
go back to reference Lichtenstein D, Meziere G, Biderman P, Gepner A, Barre O: The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997, 156: 1640-1646.CrossRefPubMed Lichtenstein D, Meziere G, Biderman P, Gepner A, Barre O: The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997, 156: 1640-1646.CrossRefPubMed
6.
go back to reference Picano E, Frassi F, Agricola E, Gligorova S, Gargani L, Mottola G: Ultrasound Lung Comets: A Clinically Useful Sign of Extravascular Lung Water. J Am Soc Echocardiogr. 2006, 19: 139-146.CrossRef Picano E, Frassi F, Agricola E, Gligorova S, Gargani L, Mottola G: Ultrasound Lung Comets: A Clinically Useful Sign of Extravascular Lung Water. J Am Soc Echocardiogr. 2006, 19: 139-146.CrossRef
7.
go back to reference Jambrik Z, Monti S, Coppola V, Agricola E, Mottola G, Miniati M, Picano E: Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol. 2004, 93: 1265-1270. 10.1016/j.amjcard.2004.02.012CrossRefPubMed Jambrik Z, Monti S, Coppola V, Agricola E, Mottola G, Miniati M, Picano E: Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol. 2004, 93: 1265-1270. 10.1016/j.amjcard.2004.02.012CrossRefPubMed
8.
go back to reference Giannotti G, Mondillo S, Galderisi M, Barbati R, Zaca V, Ballo P, Agricola E, Guerrini F: Hand-held echocardiography: added value in clinical cardiological assessment. Cardiovasc Ultrasound. 2005, 3: 7- 10.1186/1476-7120-3-7CrossRefPubMedPubMedCentral Giannotti G, Mondillo S, Galderisi M, Barbati R, Zaca V, Ballo P, Agricola E, Guerrini F: Hand-held echocardiography: added value in clinical cardiological assessment. Cardiovasc Ultrasound. 2005, 3: 7- 10.1186/1476-7120-3-7CrossRefPubMedPubMedCentral
9.
go back to reference Lichtenstein D, Meziere G: A lung ultrasound sign allowing bedside distinction between pulmonary edema and chronic obstructive pulmonary disease: the comet-tail artifact. Intensive Care Med. 1998, 24: 1331-1334. 10.1007/s001340050771CrossRefPubMed Lichtenstein D, Meziere G: A lung ultrasound sign allowing bedside distinction between pulmonary edema and chronic obstructive pulmonary disease: the comet-tail artifact. Intensive Care Med. 1998, 24: 1331-1334. 10.1007/s001340050771CrossRefPubMed
11.
go back to reference Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Marginato A, Picano E: "Ultrasound comet-tail images": a marker of pulmonary edema. Chest. 2005, 127: 1690-1695. 10.1378/chest.127.5.1690CrossRefPubMed Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Marginato A, Picano E: "Ultrasound comet-tail images": a marker of pulmonary edema. Chest. 2005, 127: 1690-1695. 10.1378/chest.127.5.1690CrossRefPubMed
12.
go back to reference Gheorghiade M, Zannad F: Modern management of acute heart failure syndromes. Eur Heart J. 2005, 7 (suppl B): B3-B7. 10.1093/eurheartj/sui006. 10.1093/eurheartj/sui006CrossRef Gheorghiade M, Zannad F: Modern management of acute heart failure syndromes. Eur Heart J. 2005, 7 (suppl B): B3-B7. 10.1093/eurheartj/sui006. 10.1093/eurheartj/sui006CrossRef
13.
go back to reference Givertz MM, Colucci WS, Braunwald E: Clinical aspects of heart failure: high-output failure, pulmonary edema. Heart Disease. Edited by: Braunwald E, Zipes DS, Libby P. 2001, 545-546. Philadelphia, PA: WB Saunders, 6, Givertz MM, Colucci WS, Braunwald E: Clinical aspects of heart failure: high-output failure, pulmonary edema. Heart Disease. Edited by: Braunwald E, Zipes DS, Libby P. 2001, 545-546. Philadelphia, PA: WB Saunders, 6,
14.
go back to reference Agricola E, Picano E, Oppizzi M, Pisani M, Meris A, Fragasso G, Margonato A: Assessment of stress-induced pulmonary interstitial edema by chest ultrasound during exercise echocardiography and its correlation with left ventricular function. J Am Soc Echocardiography. 2006, 19: 457-463. 10.1016/j.echo.2005.11.013. 10.1016/j.echo.2005.11.013CrossRef Agricola E, Picano E, Oppizzi M, Pisani M, Meris A, Fragasso G, Margonato A: Assessment of stress-induced pulmonary interstitial edema by chest ultrasound during exercise echocardiography and its correlation with left ventricular function. J Am Soc Echocardiography. 2006, 19: 457-463. 10.1016/j.echo.2005.11.013. 10.1016/j.echo.2005.11.013CrossRef
15.
go back to reference Douglas PS, Foster E, Gorcsan J, Lewis JF, Pearlman AS, Rychik J, Salcedo EE, Seward JB, Stevenson JB, Thys DM, Weitz HH, Zoghbi WA: ACC/AHA clinical competence statement on echocardiography. J Am Coll Cardiol. 2003, 41: 687-708. 10.1016/S0735-1097(02)02885-1CrossRefPubMed Douglas PS, Foster E, Gorcsan J, Lewis JF, Pearlman AS, Rychik J, Salcedo EE, Seward JB, Stevenson JB, Thys DM, Weitz HH, Zoghbi WA: ACC/AHA clinical competence statement on echocardiography. J Am Coll Cardiol. 2003, 41: 687-708. 10.1016/S0735-1097(02)02885-1CrossRefPubMed
16.
go back to reference Picano E, Lattanzi F, Orlandini A, Marini C, L'Abbate A: Stress echocardiography and the human factor: the importance of being export. J Am Coll Cardiol. 1991, 17: 666-669.CrossRefPubMed Picano E, Lattanzi F, Orlandini A, Marini C, L'Abbate A: Stress echocardiography and the human factor: the importance of being export. J Am Coll Cardiol. 1991, 17: 666-669.CrossRefPubMed
Metadata
Title
Evaluation of ultrasound lung comets by hand-held echocardiography
Authors
G Bedetti
L Gargani
A Corbisiero
F Frassi
E Poggianti
G Mottola
Publication date
01-08-2006
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2006
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/1476-7120-4-34

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