Diagnosis of Acute Heart Failure Using Inferior Vena Cava Ultrasound

Abstract

ObjectivesThe utility of bedside inferior vena cava (IVC) ultrasound (US) in the diagnosis of heart failure (HF) is unclear. The aim of this study was to determine whether IVC parameters in patients with acute heart failure (AHF) are statistically different from those without HF.MethodsThe MEDLINE database of English‐language publications from 1966 to August 2018 was searched. Retrospective and prospective studies that included either IVC expiratory diameter (IVCexp) or IVC collapsibility index (IVC‐CI) values were collected in patients with and without HF. to determine whether there was a statistical difference in the IVC parameters between these groups.ResultsA total of 27 articles with a total of 1472 patients with AHF were included. The standard mean differences for the IVCexp and IVC‐CI for the control group versus the AHF group were found to be statistically significant (P < .0001). The combined mean IVCexp values were 15.11 mm (95% confidence interval [CI], 14.19–16.02 mm) for the control group and 20.26 mm (95% CI, 14.82–25.71 mm) for the AHF group. The combined mean IVC‐CI values were 61.6% (95% CI, 48.4%–74.7%) for the control group and 30.5% (95% CI, 26.4%–34.6%) for the AHF group.ConclusionsBedside IVC US showed that a statistically significant difference existed in the IVC parameters between patients with and without AHF. Based on mean calculations, an IVCexp of greater than 2.0 cm and an IVC‐CI of less than 30% are reasonable cutoffs to suggest that a patient with acute dyspnea is more likely to have AHF than a non‐AHF condition. Given the high degree of heterogeneity across the studies and the high risk of bias, larger randomized studies are warranted to explore the use of IVC US in patients with HF.

Liver Congestion Assessed by Hepatic Vein Waveforms in Patients With Heart Failure

“…However, it remains controversial whether IVC diameter indicates right atrial pressure or prognosis in HF patients, [43][44][45] and cutoff of collapsibility of IVC diameter has been unestablished. 40,41,46 Implantable hemodynamic monitors are accurate alternatives to RHC [47][48][49] and are potentially useful to avoid rehospitalization due to worsened HF 50,51 because increases in intracardiac and pulmonary arterial pressure precede clinical decompensation. 52,53 However, these sensors are invasive, and noninvasive hemodynamic indicators are required for daily clinical settings.…”

Diagnostic accuracy of inferior vena cava evaluation in the diagnosis of acute heart failure among dyspneic patients

“…More accurately CVP can be estimated using ultrasound examination of IVC [12]. Patients with AHF are characterized by larger IVC diameter and reduced collapsibility compared to non AHF patients, even though increased CVP may not be always present [5]. Different studies have evaluated the diagnostic accuracy of IVC for the diagnosis of AHF among patients with acute dyspnea.…”

“…In the last years multi-organ ultrasound examination of the lung, heart and inferior vena cava (IVC) has become a useful tool for the differential diagnosis of acute dyspnea in the ED [2][3][4]. Since echocardiographic evaluation requires expertise and training, some studies suggest that the only sonographic assessment of IVC diameter and/or collapsibility, from which central venous pressure (CVP) can be estimated, may be enough for the identification of AHF among acutely dyspneic patients [5]. The aim of this study is to evaluate the real accuracy of the evaluation of diameter and collapsibility of IVC for the diagnosis of AHF and to evaluate the sensibility and specificity of different values of CVP for the diagnosis of AHF.…”

Use of POCUS in Chest Pain and Dyspnea in Emergency Department: What Role Could It Have?

“…A reduction in diameter accompanied by an increase in collapsibility orients us, for instance, towards a state of hypovolemia, while an increase in caliber and a smaller excursion during inspiration indicates congestion. For this reason, finding a congested IVC may suggest fluid overload and lead to a diagnosis of heart failure [18] (Figure 3). Knowing how to identify a pericardial effusion also allows us to diagnose much more dangerous clinical pictures, such as cardiac tamponades [15].…”