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Association between Lung Ultrasound B-lines and Exercise-Induced Pulmonary Hypertension in Patients with Connective Tissue Disease
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  • Kazuki Kagami,
  • Tomonari Harada,
  • Koichi Yamaguchi,
  • Shunichi Kouno,
  • Takahiro Ikoma,
  • Kuniko Yoshida,
  • Toshimitsu Kato,
  • Junichi Tomono,
  • Naoki Wada,
  • Takeshi Adachi,
  • Masahiko Kurabayashi,
  • Masaru Obokata
Kazuki Kagami
National Defense Medical College
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Tomonari Harada
Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine
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Koichi Yamaguchi
Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine
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Shunichi Kouno
Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine
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Takahiro Ikoma
Gunma University Hospital
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Kuniko Yoshida
Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine
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Toshimitsu Kato
Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine
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Junichi Tomono
Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine
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Naoki Wada
Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine
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Takeshi Adachi
National Defense Medical College
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Masahiko Kurabayashi
Gunma University Graduate of Medicine
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Masaru Obokata
Gunma University Graduate School of Medicine School of Medicine Faculty of Medicine
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Abstract

Background: Identification of elevation in pulmonary pressures during exercise may provide prognostic and therapeutic implications in patients with connective tissue disease (CTD). Interstitial lung disease (ILD) is common in CTD patients and subtle interstitial abnormalities detected by lung ultrasound could predict exercise-induced pulmonary hypertension (PH). Methods and Results: Echocardiography and lung ultrasound were performed at rest and bicycle exercise in CTD patients (n=41) and control subjects without CTD (n=24). Ultrasound B-lines were quantified by scanning four intercostal spaces in the right hemithorax. We examined the association between total B-lines at rest and the development of exercise-induced PH during ergometry exercise. Compared to controls, the number of total B-lines at rest was higher in CTD patients (0 [0, 0] vs. 2 [0, 9], p<0.0001) and was correlated with radiological severity of ILD assessed by computed tomography (fibrosis score, r=0.70, p<0.0001). Pulmonary artery systolic pressure (PASP) was increased with ergometry exercise in CTD compared to controls (48±14 vs. 35±13 mmHg, p=0.0006). The number of total B-lines at rest was highly correlated with higher PASP (r=0.52, p<0.0001) and poor right ventricular pulmonary artery coupling (tricuspid annular plane systolic excursion/PASP ratio, r=-0.31, p=0.01) during peak exercise. The number of resting B-lines predicted the development of exercise-induced PH with an area under the curve 0.79 (p=0.0003). Conclusions: These data may suggest the value of a simple resting assessment of lung ultrasound as a potential tool for assessing the risk of exercise-induced PH in CTD patients.

Peer review status:ACCEPTED

30 Apr 2021Submitted to Echocardiography
30 Apr 2021Submission Checks Completed
30 Apr 2021Assigned to Editor
03 May 2021Reviewer(s) Assigned
09 May 2021Review(s) Completed, Editorial Evaluation Pending
10 May 2021Editorial Decision: Revise Major
02 Jun 20211st Revision Received
04 Jun 2021Submission Checks Completed
04 Jun 2021Assigned to Editor
05 Jun 2021Reviewer(s) Assigned
07 Jun 2021Review(s) Completed, Editorial Evaluation Pending
11 Jun 2021Editorial Decision: Accept