Point-of-Care, Ultraportable Echocardiography Predicts Diuretic Response in Patients Admitted with Acute Decompensated Heart Failure

Abstract

BACKGROUNDRoutine management of patients with acute decompensated heart failure (ADHF) requires careful attentiveness to fluid status and diuretic treatment efficacy. New advances in ultrasound have made ultraportable echocardiography (UE) available to physicians for point-of-care use. The purpose of this study is to explore physiologic measures of intravascular fluid volume derived from UE and explore predictors of diuretic response in ADHF.METHODSVarious echocardiography imaging measurements, particularly diameter and collapse of inferior vena cava (IVC), were collected from 77 patients admitted with a primary diagnosis of ADHF. Patients were divided into two groups based on whether or not they achieved a net negative fluid output of 3 L within 48 hours. The demographic information, serum laboratory markers, and physical characteristics of the subjects were obtained to correlate with daily ultrasound measurements. Univariate and multivariate analyses were used to compare diuretic “responders” to “nonresponders.”RESULTSA negative change in the IVC diameter at 48 hours was robust in prediction of diuretic response. For every 1 mm decrease in the IVC diameter at 48 hours, there was an odds ratio of 1.62 (95% CI: 1.20–2.19) for responding to diuretic therapy independent of other variables including baseline renal filtration function and blood B-type natriuretic peptide.CONCLUSIONAssessment of central venous pressure as a proxy for passive renal congestion independently predicts initial diuretic response in ADHF. Future research is needed to further understand the individual variation in response to loop diuresis and to identify optimal treatment approaches that utilize anatomic and physiologic measures such as venous ultrasound.

Usefulness of inferior vena cava ultrasonography in outpatients with chronic heart failure

“…Besides, in ADHF patients, IVC diameter at admission has shown prognosis utility for readmission, renal impairment, and mortality . IVC diameter has been correlated with the clinical evolution of ADHF, showing improvement in diameter and collapsibility after diuretic treatment . Finally, other studies have demonstrated the prognosis power of IVC ultrasonography, prior to discharge after hospitalization for ADHF, to predict readmission …”

“…[20][21][22][23] IVC diameter has been correlated with the clinical evolution of ADHF, showing improvement in diameter and collapsibility after diuretic treatment. [24][25][26][27][28] Finally, other studies have demonstrated the prognosis power of IVC ultrasonography, prior to discharge after hospitalization for ADHF, to predict readmission. 29,30 Despite extensive research in this area, the role of IVC ultrasonography in chronic HF is less studied and cutoff points for outpa- parameter and all-cause mortality, but they did not compare it with natriuretic peptides.…”

Differences in pharmacological property between combined therapy of the vasopressin V2-receptor antagonist tolvaptan plus furosemide and monotherapy of furosemide in patients with hospitalized heart failure

“…Second, we measured IVC diameter by echocardiography as a substitute for the assessment of intravascular volume status, although the utility of IVC diameter as the absolute value has not been established, particularly in patients who are breathing spontaneously [47][48][49]. Therefore, we sought to assess relative changes in volume status by comparing IVC measurements at two time points [50][51][52]. Third, the measurement of BIA in HF can be affected by multiple factors, and its applicability remains controversial [53].…”

Point‐of‐care ultrasound: Closing guideline gaps in screening for valvular heart disease

“…Its role in non‐emergent settings is still emerging. Among non‐emergent conditions, POCUS can improve physical exam, 46 guide diuresis, 47 predict risk of rehospitalization, 48 and safely discharge cardiac patients from the clinic 36 …”