Swimming Induced Pulmonary Edema (SIPE), Pulmonary Edema, Lung Diseases, Heart Function Tests
Conditions
Keywords
Echocardiography, Electrocardiography, Troponin
Brief summary
Acute or chronic cardiac dysfunction could be a contributing factor to swimming-induced pulmonary edema (SIPE). Knowledge on cardiac function in SIPE is limited and recommendations for cardiac evaluation of patients with SIPE are lacking. The present study was designed to assess cardiac function in patients with SIPE and in asymptomatic swimmers.
Detailed description
Swimming induced pulmonary edema (SIPE) is an unusual condition occuring during swimming in cold open water. SIPE is characterized by acute onset of dyspnea and cough, excessive sputum and occasionally hemoptysis. Reversible myocardial dysfunction has been described in swimmers with SIPE and divers with immersion pulmonary edema (IPE). Cardiac dysfunction has also been discussed as a contributing factor triggering SIPE. However, prevalence, severity and prognosis of myocardial dysfunction in patients with SIPE is unknown. Official recommendations for cardiac evaluation of patients after an acute episode of SIPE is lacking. This case-control-study intends to assess cardiac function in patients with SIPE and in asymptomatic swimmers. We study a large cohort of approximately 12 000 swimmers during Vansbrosimningen, Sweden's biggest annual open water event, with a yearly incidence of SIPE of about 0,4%. Cardiac function is evaluated after swimming as well as at rest by echocardiography, 12-lead electrocardiogram and cardiac biomarkers (Troponin I, NT-pro-BNP).
Interventions
DIAGNOSTIC_TESTEchocardiography
Echocardiography after swimming (acute) and at rest (baseline)
DIAGNOSTIC_TESTElectrocardiogram (ECG)
Electrocardiogram (ECG) after swimming (acute) and at rest (baseline)
DIAGNOSTIC_TESTCardiac biomarkers
high sensitive (hs)-Troponin I and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) after swimming (acute) and at rest (baseline)
Sponsors
Dalarna County Council, Sweden
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
for patients: * respiratory symptoms during or after swimming at the Vansbrosimningen open water swimming event * diagnosis SIPE by signs of pulmonary edema on lung ultrasound * peripheral oxygen saturation ≤95% for controls: * completion of a swimming race of the Vansbrosimningen open water swimming event. * no respiratory symptoms during or after swimming * no signs of pulmonary edema on lung ultrasound * matched to patients with SIPE regarding sex and age
Exclusion criteria
* declined consent * hemodynamic instability or decreased consciousness
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acute cardiac biomarkers - NT-pro-BNP | 4-6 hours after termination of swimming | Venous samples. Measurement of NT-pro-BNP (ng/L) |
| Acute Echocardiography | within 4 hours after termination of swimming | Transthoracic echocardiography with parasternal, apical and subcostal views. Including measurement of ventricular wall size, left ventricular strain, ejection fraction according to the modified Simpson method, diastolic function (using tissue doppler, mitral flow and pulmonary vein flow), right ventricular tricuspid annular plane systolic excursion (TAPSE), pressure gradient over the tricuspid valve, assessment of valve dysfunction, size and respiratory variation of the inferior vena cava, assessment of pericardial fluid. |
| Acute Electrocardiogram (ECG) - Rytm analysis | within 4 hours after termination of swimming | 12-lead electrocardiogram (ECG). Rytm analysis and frequency (beats per minute) |
| Acute Electrocardiogram (ECG) - Heart axis | within 4 hours after termination of swimming | 12-lead electrocardiogram (ECG). Assessment of QRS-axis (degrees) |
| Acute Electrocardiogram (ECG) - Amplitudes and intervals | within 4 hours after termination of swimming | 12-lead electrocardiogram (ECG). Duration of PQ-interval (ms), QRS-complex (ms), QT-interval (ms), QRS amplitude (mV) |
| Acute Electrocardiogram (ECG) - Signs of myocardial ischemia | within 4 hours after termination of swimming | 12-lead electrocardiogram (ECG). ST-elevation, ST-depression, T-wave inversion, Q wave. |
| Acute cardiac biomarkers - Troponin I | 4-6 hours after termination of swimming | Venous samples. Measurement of hs-Troponin I (ng/L). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Baseline Echocardiography | within 12 months after swimming | Transthoracic echocardiography with parasternal, apical and subcostal views. Examination at rest. Including measurement of ventricular wall size, left ventricular strain, ejection fraction according to the modified Simpson method, diastolic function (using tissue doppler, mitral flow and pulmonary vein flow), right ventricular tricuspid annular plane systolic excursion (TAPSE), pressure gradient over the tricuspid valve, assessment of valve dysfunction, size and respiratory variation of the inferior vena cava, assessment of pericardial fluid. |
| Baseline Electrocardiogram (ECG) - Rytm analysis | within 12 months after swimming | 12-lead Electrocardiogram (ECG). Examination at rest. Rytm analysis and frequency (beats per minute) |
| Baseline Electrocardiogram (ECG)- Heart axis | within 12 months after swimming | 12-lead Electrocardiogram (ECG). Examination at rest. Assessment of QRS-axis (degrees) |
| Baseline Electrocardiogram (ECG) - Amplitudes and intervals | within 12 months after swimming | 12-lead Electrocardiogram (ECG). Examination at rest. Duration of PQ-interval (ms), QRS-complex (ms), QT-interval (ms), QRS amplitude (mV) |
| Baseline Electrocardiogram (ECG) - Signs of myocardial ischemia | within 12 months after swimming | 12-lead Electrocardiogram (ECG). Examination at rest. ST-elevation, ST-depression, T-wave inversion, Q wave. |
| Baseline cardiac biomarkers - Troponin I | within 12 months after swimming | Venous samples. Measurement of hs-Troponin I (ng/L). Examination at rest |
| Baseline cardiac biomarkers - NT-pro-BNP | within 12 months after swimming | Venous samples. Measurement of NT-pro-BNP (ng/L). Examination at rest |
Countries
Sweden
Outcome results
None listed