Clinical correlates of hand‐held ultrasound‐guided assessments of the inferior vena cava in patients with acute decompensated heart failure

Abstract

Background: Accurately assessing volume status in acutely decompensated heart failure (ADHF) can be challenging. Inferior vena cava (IVC) dynamics by echocardiography allow indirect assessment of volume status in these patients. Recently introduced hand-held ultrasound devices are promising. We aimed to describe the clinical correlates of volume status assessment using a hand-held ultrasound device in ADHF. Methods:In this prospective study, we evaluated 106 patients admitted with ADHF.First scan was performed within 24 hours of admission and timed in reference to first dose of intravenous diuretic. Daily resting and inspiratory (sniff) IVC diameters were measured according to standard echocardiography methods during hospitalization including the day of discharge. IVC collapsibility index (IVC-CI = Maximum IVC diameter-Inspiratory IVC diameter/maximum diameter; <0.5 representing hypervolemia) was calculated. Primary study endpoint was 30-day readmission. Research activities were independent of clinical decision-making.Results: Data for 106 patients was analyzed. Mean age was 66.7 ± 13.8 years, of which 53.8% were females, and a mean ejection fraction was 39 ± 18%. Initial scan of the IVC was obtained at an average time of 5.2 ± 8.04 hours from first diuretic dose. 81.2% of patients at admission had an IVC-CI <0.5. 63.2% patients had an IVC-CI <0.5 at discharge. There were no significant differences in age, length of stay, diuretic dose, or 30-day readmissions between patients with a discharge IVC-CI <0.5 vs ≥ 0.5. Conclusion:Hand-held ultrasound assessment of IVC-CI in ADHF patients, although a feasible concept, is unable to predict 30-day readmissions in our study. Further prospective studies are necessary. K E Y W O R D Sdecompensated heart failure, diuresis, hand-held ultrasound, inferior vena cava | 23 PATNAIK eT Al.

In adults discharged after an acute congestive heart failure exacerbation, does point-of-care ultrasound assessment of the inferior vena cava predict hospital readmission?

“…A 2020 prospective, single-center, cohort study (N=106) investigated if point-of-care ultrasound assessment of the inferior vena cava (IVC) in patients with acute decompensated heart failure (ADHF) correlated with other measures of volume status and could predict readmission. 1 Patients were hospitalized for ADHF and excluded for body mass index greater than 40 kg/m 2 , severe tricuspid regurgitation, intensive care unit (ICU) admission, or renal replacement therapy. Mean age of participants was 66.7 years old and 54% were female with a mean ejection fraction of 39%.…”