How to Incorporate Remote Dielectric Sensing System and Lung Ultrasound in Patients with Acute Congestive Heart FailureKeywords
Heart Failure; Hemodynamics; Lung
Palavras-chave
Insuficiência Cardíaca; Hemodinâmica; Pulmão
Keywords
Heart Failure; Hemodynamics; Lung
Palavras-chave
Insuficiência Cardíaca; Hemodinâmica; Pulmão
To Editor
Accurate assessment of pulmonary congestion is pivotal for the optimal management of congestive heart failure. The remote dielectric sensing (ReDS) system represents a recently developed non-invasive technology designed to quantify lung fluid volume without requiring specialized expertise. Kobalava et al. demonstrated a moderate correlation between the ReDS system and lung ultrasound.1 However, several concerns warrant further discussion.
In the current study, certain patients exhibited higher lung ultrasound findings (as indicated by the sum of B-lines) despite lower ReDS (%) values.1 Could the authors provide an explanation for this observed discordance? It is worth noting that various confounding factors may influence ReDS (%) measurements. For example, ReDS (%) tends to be underestimated in individuals with chronic obstructive pulmonary disease or low body mass index.2
Given the inter-individual variability in ReDS (%) measurements, direct comparisons of absolute ReDS (%) values across patients may pose significant challenges. As an alternative, the ratio of ReDS (%) between hospital admission and discharge could serve as a valuable metric to evaluate the improvement of pulmonary congestion during the index hospitalization.3
The definition of significant pulmonary congestion is generally based on a sum of B-lines equal to or exceeding three rather than five.4 How would the concordance between the ReDS system and lung ultrasound be affected if this revised threshold for pulmonary congestion were applied?
Building upon their findings, how might the ReDS system and lung ultrasound be optimally integrated into clinical practice? For instance, we suggest utilizing the ReDS system for less critically ill patient cohorts, as it is particularly effective in identifying subclinical pulmonary congestion.4 Conversely, lung ultrasound may be more appropriate for critically ill patients, as these individuals often face challenges in assuming a seated position with natural breathing, which is required for proper ReDS device application and measurement.2 The lung ultrasound can be applied without patients’ cooperation.
References
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1 Kobalava Z, Safarova AF, Tolkacheva V, Cabello-Montoya FE, Zorya OT, Nazarov IS, et al. Assessment of Pulmonary Congestion According to Ultrasound and Remote Dielectric Sensing (ReDS) in Patients Hospitalized with Heart Failure. Arq Bras Cardiol. 2024;121(10):e20240128. doi: 10.36660/abc.20240128.
» https://doi.org/10.36660/abc.20240128 -
2 Imamura T, Narang N, Kinugawa K. Clinical Implications of Remote Dielectric Sensing System to Estimate Lung Fluid Levels. J Cardiol. 2023;81(3):276-82. doi: 10.1016/j.jjcc.2022.07.014.
» https://doi.org/10.1016/j.jjcc.2022.07.014 -
3 Izumida T, Imamura T, Koi T, Nakagaito M, Onoda H, Tanaka S, et al. Prognostic Impact of Residual Pulmonary Congestion Assessed by Remote Dielectric Sensing System in Patients Admitted for Heart Failure. ESC Heart Fail. 2024;11(3):1443-51. doi: 10.1002/ehf2.14690.
» https://doi.org/10.1002/ehf2.14690 -
4 Izumida T, Imamura T, Kinugawa K. Remote Dielectric Sensing and Lung Ultrasound to Assess Pulmonary Congestion. Heart Vessels. 2023;38(4):517-22. doi: 10.1007/s00380-022-02190-0.
» https://doi.org/10.1007/s00380-022-02190-0
