Cardiac Function in Swimming-Induced Pulmonary Edema (SIPE)

Dalarna County Council, Sweden120 enrolled

Overview

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.

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).

Study Type

OBSERVATIONAL

Enrollment

120

Conditions

Swimming Induced Pulmonary Edema (SIPE)Pulmonary Edema Lung Diseases Heart Function Tests

Interventions

EchocardiographyDIAGNOSTIC_TEST

Echocardiography after swimming (acute) and at rest (baseline)

Electrocardiogram (ECG)DIAGNOSTIC_TEST

Electrocardiogram (ECG) after swimming (acute) and at rest (baseline)

Cardiac biomarkersDIAGNOSTIC_TEST

high sensitive (hs)-Troponin I and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) after swimming (acute) and at rest (baseline)

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

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

Locations (1)

Center of Clinical Research Dalarna

Falun, Sweden

RECRUITING

Outcomes

Primary Outcomes

Acute Echocardiography

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.

Time frame: within 4 hours after termination of swimming

Acute Electrocardiogram (ECG) - Rytm analysis

12-lead electrocardiogram (ECG). Rytm analysis and frequency (beats per minute)

Time frame: within 4 hours after termination of swimming

Acute Electrocardiogram (ECG) - Heart axis

12-lead electrocardiogram (ECG). Assessment of QRS-axis (degrees)

Time frame: within 4 hours after termination of swimming

Acute Electrocardiogram (ECG) - Amplitudes and intervals

12-lead electrocardiogram (ECG). Duration of PQ-interval (ms), QRS-complex (ms), QT-interval (ms), QRS amplitude (mV)

Time frame: within 4 hours after termination of swimming

Acute Electrocardiogram (ECG) - Signs of myocardial ischemia

12-lead electrocardiogram (ECG). ST-elevation, ST-depression, T-wave inversion, Q wave.

Time frame: within 4 hours after termination of swimming

Acute cardiac biomarkers - Troponin I

Venous samples. Measurement of hs-Troponin I (ng/L).

Time frame: 4-6 hours after termination of swimming

Acute cardiac biomarkers - NT-pro-BNP

Data from ClinicalTrials.gov

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Secondary Outcomes

Baseline Echocardiography

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.