Cardiac Function in Swimming-Induced Pulmonary Edema (SIPE)

Study Overview
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Brief Summary
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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.

Detailed Description
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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).

Official Title
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Cardiac Function in Swimming-Induced Pulmonary Edema (SIPE) - a Case Control Study

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

Intervention / Treatment
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* Diagnostic Test: Echocardiography
* Diagnostic Test: Electrocardiogram (ECG)
* Diagnostic Test: Cardiac biomarkers


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| patients with SIPE<br>Adult patients (age ≥18 years) with SIPE-diagnosis during Vansbrosimningen and peripheral oxygen saturation ≤95%. SIPE-diagnosis based on pulmonary edema on lung ultrasound. | Diagnostic Test: Echocardiography<br>* Echocardiography after swimming (acute) and at rest (baseline)<br>Diagnostic Test: Electrocardiogram (ECG)<br>* Electrocardiogram (ECG) after swimming (acute) and at rest (baseline)<br>Diagnostic Test: Cardiac biomarkers<br>* high sensitive (hs)-Troponin I and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) after swimming (acute) and at rest (baseline)<br>|
| control group<br>Swimmers completing Vansbrosimningen without respiratory symptoms or signs of pulmonary edema on lung ultrasound. Matched to patients with SIPE for age and gender. | Diagnostic Test: Echocardiography<br>* Echocardiography after swimming (acute) and at rest (baseline)<br>Diagnostic Test: Electrocardiogram (ECG)<br>* Electrocardiogram (ECG) after swimming (acute) and at rest (baseline)<br>Diagnostic Test: Cardiac biomarkers<br>* high sensitive (hs)-Troponin I and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) after swimming (acute) and at rest (baseline)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | 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). | 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 | 

Secondary Outcome Measures

| Outcome Measure | 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. | 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Echocardiography, Electrocardiography, Troponin