Quantifying Diaphragm Blood Flow With Contrast-Enhanced Ultrasound in Humans.

Autor: Bird JD; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada., Lance ML; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada., Banser TRW; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada., Thrall SF; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada., Cotton PD; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada., Lindner JR; Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA., Eves ND; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada., Dominelli PB; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada., Foster GE; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada. Electronic address: glen.foster@ubc.ca.
Jazyk: angličtina
Zdroj: Chest [Chest] 2024 Oct; Vol. 166 (4), pp. 821-834. Date of Electronic Publication: 2024 May 29.
DOI: 10.1016/j.chest.2024.04.026
Abstrakt: Background: Despite the known interplay between blood flow and function, to our knowledge, there is currently no minimally invasive method to monitor diaphragm hemodynamics. We used contrast-enhanced ultrasound to quantify relative diaphragm blood flow (Q˙ DIA ) in humans and assessed the technique's efficacy and reliability during graded inspiratory pressure threshold loading. We hypothesized that: (1) Q˙ DIA would linearly increase with pressure generation, and (2) that there would be good test-retest reliability and interanalyzer reproducibility.
Research Question: Can we validate what is, to our knowledge, the first minimally invasive method to measure relative diaphragm blood flow in humans?
Study Design and Methods: Quantitative contrast-enhanced ultrasound of the costal diaphragm was performed in healthy participants (10 male participants, 6 female participants; mean age 28 ± 5 years; BMI 22.8 ± 2.0 kg/m) during unloaded breathing and three stages of loaded breathing on two separate days. Gastric and esophageal balloon catheters measured transdiaphragmatic pressure. Ultrasonography was performed during a constant-rate IV infusion of lipid-stabilized microbubbles following each stage. Ultrasound images were acquired after a destruction-replenishment sequence and diaphragm specific time-intensity data were used to determine Q˙ DIA by two individuals.
Results: Transdiaphragmatic pressure for unloaded and each loading stage were 15.2 ± 0.8, 26.1 ± 0.8, 34.6 ± 0.8, and 40.0 ± 0.8 percentage of the maximum, respectively. Q˙ DIA increased with each stage of loading (3.1 ± 3.1, 6.9 ± 3.6, 11.0 ± 4.9, and 13.5 ± 5.4 acoustic units/s; P < .0001). The linear relationship between diaphragmatic flow and pressure was reproducible from day to day. Q˙ DIA had good to excellent test-retest reliability (0.86 [0.77, 0.92]; P < .0001) and excellent interanalyzer reproducibility (0.93 [0.90, 0.95]; P < .0001) with minimal bias.
Interpretation: Relative Q˙ DIA measurements had valid physiological underpinnings, were reliable day-to-day, and were reproducible analyzer-to-analyzer. This study indicated that contrast-enhanced ultrasound is a viable, minimally invasive method for assessing costal Q˙ DIA in humans and may provide a tool to monitor diaphragm hemodynamics in clinical settings.
Competing Interests: Financial/Nonfinancial Disclosures None declared.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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