Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort

Kobayashi, Masatake; Douair, Amine; Duarte, Kévin; Jaeger, Déborah; Giacomin, Gaetan; Bassand, Adrien; Jeangeorges, Victor; Vuillaume, Laure Abensur; Preud’homme, Gregoire; Huttin, Olivier; Zannad, Faı̈ez; Rossignol, Patrick; Chouihed, Tahar; Girerd, Nicolas

doi:10.1371/journal.pmed.1003419

Cited by 11 publications

(6 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The secondary endpoints included the rate of survival to discharge, successful HT, or LV assist device (LVAD) implantation, the duration of mechanical ventilation (MV), improvement of pulmonary oedema, and any adverse events related to VA-ECMO. Pulmonary oedema was assessed using the semiquantitative congestion score index (CSI) [16][17][18] on chest radiography (online supplementary Appendix S1).…”

Section: Discussionmentioning

confidence: 99%

Early left atrial venting versus conventional treatment for left ventricular decompression during venoarterial extracorporeal membrane oxygenation support: The EVOLVE‐ECMO randomized clinical trial

Park,

Yang,

Ahn

et al. 2023

European J of Heart Fail

View full text Add to dashboard Cite

AimsFew studies have reported data on the optimal timing of left ventricular (LV) unloading during venoarterial extracorporeal membrane oxygenation (VA‐ECMO) for cardiac arrest or shock. This study evaluated the feasibility of an early LV unloading strategy compared with a conventional strategy in VA‐ECMO.Methods and resultsBetween December 2018 and August 2022, 60 patients at two institutions were randomized in a 1:1 ratio to receive early (n = 30) or conventional (n = 30) LV unloading strategies. The early LV unloading strategy was defined as LV unloading performed at the time of VA‐ECMO insertion. LV unloading was performed using a percutaneous transseptal left atrial cannulation via the femoral vein incorporated into the ECMO venous circuit. The early and conventional LV unloading groups included 29 (96.7%) and 23 (76.7%) patients, respectively (median time from VA‐ECMO insertion to LV unloading: 48.4 h, interquartile range 47.8–96.5 h). The groups showed no significant differences in the rate of VA‐ECMO weaning as the primary endpoint (70.0% vs. 76.7%; relative risk 0.91; 95% confidence interval 0.67–1.24; p = 0.386) and survival to discharge (53.3% vs. 50.0%, p = 0.796). However, the pulmonary congestion score index at 48 h after LV unloading was significantly improved only in the early LV unloading group (2.0 ± 0.7 vs. 1.7 ± 0.6 at baseline vs. at 48 h; p = 0.008).ConclusionsCompared with the conventional approach, early LV unloading did not improve the VA‐ECMO weaning rate, despite the rapid improvement in pulmonary congestion. Therefore, the results of this study do not support the application of this strategy after VA‐ECMO insertion.

show abstract

Section: Discussionmentioning

confidence: 99%

Early left atrial venting versus conventional treatment for left ventricular decompression during venoarterial extracorporeal membrane oxygenation support: The EVOLVE‐ECMO randomized clinical trial

Park,

Yang,

Ahn

et al. 2023

European J of Heart Fail

View full text Add to dashboard Cite

show abstract

“…The severity of the radiographic pulmonary congestion was evaluated using a previously reported CSI ( Figure 2 ) [ 3 , 4 , 5 ]. The scoring of the congestion was performed on each 6-segment of lung fields.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, congestion score index (CSI), which is a semi-quantitative approach to evaluate pulmonary congestion based on a 6-segment evaluation of CXR, scoring each zone from 0 (no congestion) to 3 (intense alveolar pulmonary edema), has been proposed to overcome the above challenges. Several studies have demonstrated its utility for assessing pulmonary congestion [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Correlation between Remote Dielectric Sensing and Chest X-Ray to Assess Pulmonary Congestion

Izumida

Imamura

Hori

et al. 2023

JCM

View full text Add to dashboard Cite

Background: Chest X-ray is a practical tool to semi-qualify pulmonary congestion. Remote dielectric sensing (ReDS) is a recently introduced, non-invasive, electromagnetic energy-based technology to quantify pulmonary congestion without expert technique. We compared these two modalities to clarify appropriate clinical situations for each modality. Methods: ReDS and chest X-ray measurements were prospectively performed on admission in consecutive hospitalized patients with cardiovascular diseases. In the chest X-ray, the congestive score index (CSI) was calculated blindly by two independent experts and averaged. CSIs were correlated with ReDS values. Results: A total of 458 patients (76 (69, 82) years old, 267 men, and 130 heart failure) were included. Median ReDS value was 28% (25%, 33%). There was a mild correlation between ReDS values and CSIs (r = 0.329, p < 0.001). The correlation between ReDS values and CSIs became stronger in the heart failure cohort (r = 0.538, p < 0.001). In patients with mild congestion (ReDS <35%), ReDS values, instead of CSI, stratified the degree of congestion. In patients with severe congestion (ReDS >35%), both modalities stratified the degree of congestion. Conclusions: Both chest X-ray and ReDS are useful for assessing severe pulmonary congestion, whereas ReDS would be preferred to chest X-ray in stratifying the severity of mild pulmonary congestion.

show abstract

“…The Pathway of dyspneic patients in Emergency (PARADISE) cohort is a retrospective cohort study including consecutive acute dyspneic patients aged 18 years or older who admitted for the ED of the Nancy University Hospital (France) between January 1, 2015 and December 31, 2015 as previously reported ( 14 , 17 , 18 ). These patients were systematically reviewed and selected by investigators using the hospital's electronic ED charts (RESURGENCES).…”

Section: Methodsmentioning

confidence: 99%

A Combination of Chest Radiography and Estimated Plasma Volume May Predict In-Hospital Mortality in Acute Heart Failure

Kobayashi

Douair

Coiro

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

Background: Patients with heart failure (HF) often display dyspnea associated with pulmonary congestion, along with intravascular congestion, both may result in urgent hospitalization and subsequent death. A combination of radiographic pulmonary congestion and plasma volume might screen patients with a high risk of in-hospital mortality in the emergency department (ED).Methods: In the pathway of dyspneic patients in emergency (PARADISE) cohort, patients admitted for acute HF were stratified into 4 groups based on high or low congestion score index (CSI, ranging from 0 to 3, high value indicating severe congestion) and estimated plasma volume status (ePVS) calculated from hemoglobin/hematocrit.Results: In a total of 252 patients (mean age, 81.9 years; male, 46.8%), CSI and ePVS were not correlated (Spearman rho <0 .10, p > 0.10). High CSI/high ePVS was associated with poorer renal function, but clinical congestion markers (i.e., natriuretic peptide) were comparable across CSI/ePVS categories. High CSI/high ePVS was associated with a four-fold higher risk of in-hospital mortality (adjusted-OR, 95%CI = 4.20, 1.10-19.67) compared with low CSI/low ePVS, whereas neither high CSI nor ePVS alone was associated with poor prognosis (all-p-value > 0.10; Pinteraction = 0.03). High CSI/high ePVS improved a routine risk model (i.e., natriuretic peptide and lactate)(NRI = 46.9%, p = 0.02), resulting in high prediction of risk of in-hospital mortality (AUC = 0.85, 0.82-0.89).Conclusion: In patients hospitalized for acute HF with relatively old age and comorbidity burdens, a combination of CSI and ePVS was associated with a risk of in-hospital death, and improved prognostic performance on top of a conventional risk model.

show abstract

Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort

Cited by 11 publications

References 51 publications

Early left atrial venting versus conventional treatment for left ventricular decompression during venoarterial extracorporeal membrane oxygenation support: The EVOLVE‐ECMO randomized clinical trial

Early left atrial venting versus conventional treatment for left ventricular decompression during venoarterial extracorporeal membrane oxygenation support: The EVOLVE‐ECMO randomized clinical trial

Correlation between Remote Dielectric Sensing and Chest X-Ray to Assess Pulmonary Congestion

A Combination of Chest Radiography and Estimated Plasma Volume May Predict In-Hospital Mortality in Acute Heart Failure

Contact Info

Product

Resources

About