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

Abstract

Acute dyspnea is one of the main reasons for admission to the Emergency Department (ED). A rapid and accurate diagnosis can be lifesaving for these patients. Particularly, it is important to differentiate between dyspnea due to acute heart failure (AHF) and dyspnea of pulmonary origin. 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 among dyspneic patients. We analyzed 155 patients admitted for acute dyspnea to the ED of “Maurizio Bufalini” hospital in Cesena (Italy) and “Antonio Cardarelli” hospital in Naples (Italy) from November 2014 to April 2017. All patients underwent ultrasound of inferior vena cava (IVC) examination with a hand-held device in addition to the traditional pathway. Patients were classified into AHF group or non-AHF group according to the current guidelines. The final diagnosis was AHF in 64 patients and dyspnea of non-cardiac origin in 91 patients. Sensibility and specificity of IVC hypo-collapsibility was 75.81% (95% CI 63.26% to 85.78%) and 67.74% (95% CI 57.25% to 77.07%) for the diagnosis of AHF. Sensibility and specificity of IVC dilatation was 69.35% (95% CI 56.35% to 80.44%) and 74.19% (95%CI 64.08% to 82.71%) for the diagnosis of AHF. AUC was 0.718 (0.635-0.801) for IVC hypo-collapsibility, 0.718 (0.634-0.802) for IVC dilatation. Our study demonstrated that the sonographic assessment of IVC diameter and collapsibility is suboptimal to differentiate acute dyspnea due to AHF or other causes in the emergency setting.

Assessment of E/A ratio helps emergency clinicians in the management of patients with acute dyspnea

“…Left atrium was considered dilated if anteroposterior diameter (in the parasternal long-axis view) was visually estimated to be > 4 cm in both genders [13]. The IVC was evaluated in subcostal view for the presence of dilatation (visually estimated to be > 2 cm) and hypo-reactivity with breathing (variation of size < 50% about) [21]. LV diastolic function was evaluated using pulse wave doppler at the tips of the opened mitral valve in 4-chamber apical view and E wave velocity and E/A ratio were recorded.…”