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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).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| patients with SIPE | Adult patients (age ≥18 years) with SIPE-diagnosis during "Vansbrosimningen" and peripheral oxygen saturation ≤95%. SIPE-diagnosis based on pulmonary edema on lung ultrasound. |
| |
| control group | Swimmers completing "Vansbrosimningen" without respiratory symptoms or signs of pulmonary edema on lung ultrasound. Matched to patients with SIPE for age and gender. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Echocardiography | Diagnostic Test | Echocardiography after swimming (acute) and at rest (baseline) |
|
| Measure | Description | Time Frame |
|---|---|---|
| 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. | within 4 hours after termination of swimming |
| Acute Electrocardiogram (ECG) - Rytm analysis | 12-lead electrocardiogram (ECG). Rytm analysis and frequency (beats per minute) | within 4 hours after termination of swimming |
| Acute Electrocardiogram (ECG) - Heart axis | 12-lead electrocardiogram (ECG). Assessment of QRS-axis (degrees) | 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) | 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. | within 4 hours after termination of swimming |
| Acute cardiac biomarkers - Troponin I | Venous samples. Measurement of hs-Troponin I (ng/L). |
| Measure | Description | Time Frame |
|---|---|---|
| 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. |
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Inclusion Criteria:
for patients:
for controls:
Exclusion criteria:
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All adults (age ≥18 years) that participate in a swimming race during Vansbrosimningen open water swimming event.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Center of Clinical Research Dalarna | Recruiting | Falun | 79182 | Sweden |
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| ID | Term |
|---|---|
| D011654 | Pulmonary Edema |
| D008171 | Lung Diseases |
| ID | Term |
|---|---|
| D012140 | Respiratory Tract Diseases |
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| ID | Term |
|---|---|
| D004452 | Echocardiography |
| D004562 | Electrocardiography |
| ID | Term |
|---|---|
| D057791 | Cardiac Imaging Techniques |
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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| Electrocardiogram (ECG) | Diagnostic Test | Electrocardiogram (ECG) after swimming (acute) and at rest (baseline) |
|
| Cardiac biomarkers | Diagnostic Test | high sensitive (hs)-Troponin I and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) after swimming (acute) and at rest (baseline) |
|
| 4-6 hours after termination of swimming |
| Acute cardiac biomarkers - NT-pro-BNP | Venous samples. Measurement of NT-pro-BNP (ng/L) | 4-6 hours after termination of swimming |
| within 12 months after swimming |
| Baseline Electrocardiogram (ECG) - Rytm analysis | 12-lead Electrocardiogram (ECG). Examination at rest. Rytm analysis and frequency (beats per minute) | within 12 months after swimming |
| Baseline Electrocardiogram (ECG)- Heart axis | 12-lead Electrocardiogram (ECG). Examination at rest. Assessment of QRS-axis (degrees) | within 12 months after swimming |
| Baseline Electrocardiogram (ECG) - Amplitudes and intervals | 12-lead Electrocardiogram (ECG). Examination at rest. Duration of PQ-interval (ms), QRS-complex (ms), QT-interval (ms), QRS amplitude (mV) | within 12 months after swimming |
| Baseline Electrocardiogram (ECG) - Signs of myocardial ischemia | 12-lead Electrocardiogram (ECG). Examination at rest. ST-elevation, ST-depression, T-wave inversion, Q wave. | within 12 months after swimming |
| Baseline cardiac biomarkers - Troponin I | Venous samples. Measurement of hs-Troponin I (ng/L). Examination at rest | within 12 months after swimming |
| Baseline cardiac biomarkers - NT-pro-BNP | Venous samples. Measurement of NT-pro-BNP (ng/L). Examination at rest | within 12 months after swimming |
| D014463 | Ultrasonography |
| D006334 | Heart Function Tests |
| D003935 | Diagnostic Techniques, Cardiovascular |
| D004568 | Electrodiagnosis |