Ultrasound unveiling:Decoding venous congestion in heart failure for precision management of fluid status

This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart failure.While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions.In particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions.Integrating specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.

Impact of preoperative carbohydrate loading on gastric volume in patients with type 2 diabetes

BACKGROUND Enhanced recovery after surgery advocates that consuming carbohydrates two hours before anesthesia is beneficial to the patient’s recovery.Patients with diabetes are prone to delayed gastric emptying.Different guidelines for preoperative carbohydrate consumption in patients with diabetes remain controversial due to concerns about the risk of regurgitation,aspiration and hyperglycemia.Ultrasonic gastric volume(GV)assessment and blood glucose monitoring can comprehensively evaluate the safety and feasibility of preoperative carbohydrate intake in type 2 diabetes(T2 D)patients.AIM To evaluate the impact of preoperative carbohydrate loading on GV before anesthesia induction in T2 D patients.METHODS Patients with T2 D receiving surgery under general anesthesia from December 2019 to December 2020 were included.A total of 78 patients were randomly allocated to 4 groups receiving 0,100,200,or 300 m L of carbohydrate loading 2 h before anesthesia induction.Gastric volume per unit weight(GV/W),Perlas grade,changes in blood glucose level,and risk of reflux and aspiration were evaluated before anesthesia induction.RESULTS No significant difference was found in GV/W among the groups before anesthesia induction(P>0.05).The number of patients with Perlas grade II and GV/W>1.5 m L/kg did not differ among the groups(P>0.05).Blood glucose level increased by>2 mmol/L in patients receiving 300 m L carbohydrate drink,which was significantly higher than that in groups 1 and 2(P<0.05).CONCLUSION Preoperative carbohydrate loading<300 m L 2 h before induction of anesthesia in patients with T2 D did not affect GV or increase the risk of reflux and aspiration.Blood glucose levels did not change significantly with preoperative carbohydrate loading of<200 m L.However,300 m L carbohydrate loading may increase blood glucose levels in patients with T2 D before induction of anesthesia.

Assessment of angiographic coronary slow flow phenomenon with intracoronary ultrasound and doppler flow mapping

In order to study the mechanism of angiographic coronary slow flow phenomenon (SF), intracoronary ultrasound (ICUS) and Doppler (ICD) were performed in 14 patients with angiographic SF phenomenon but with normal angiograms and in 16 patients with normal angiographic coronary flow (NF). A 3.5 F, 20 MHz ultrasound catheter (Boston Scientific) was used for ICUS and a 0.014 inch FloWire (Cardiometrics) was used for ICD. Coronary flow velocity including average peak velocity (APV), maximal peak velocity (MPV) at rest and at hyperemia as well as coronary flow reserve (CFR) were compared in both groups in comparison to the presence or absence of plaque formation based on ICUS. CFR in the SF group (4.2±1.1) was even higher than that of the NF group (3.1±0.6, P<0.001). Department of Cardiology, University GHS Essen, Germany (Ge JB, Simon H, Jeremias A, Liu FQ, Grge G, Haude M, Baumgart D and Erbel R) Significant differences were also found concerning the APV and MPV among both groups (both P <0.001). Plaque formation was found in 7/13 patients with a lumen reduction of 21%±24% in SF group and in 7/16 of the NF group with a lumen reduction of 19%±17%. Comparison of APV, MPV and CFR in SF and NF grups. Comparison of APV, MPV and CFR in SF and NF groups[BHDFG1*2,WK8ZQ1,WK11DW,WK11DWW] SF group NF groupAPV (cm/s) Rest 7.7±2.0 21.1±5.0 * Peak31.7±14.961.3±14.2 *MPV (cm/s) Rest17.4±4.637.0±11.4 * Peak56.8±14.981.8±17.7 *CFR4.2±1.13.1±0.6 # * P<0.001, #P=0.002. Coronary slow flow phenomenon in angiography indicates reduced resting flow velocity without reduction of coronary flow reserve.