The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients; best sonographic measurement method?

Yamanoğlu, Adnan; Yamanoğlu, Nalan Gökçe Çelebi; Parlak, İsmet; Pınar, Pelin; Tosun, Ali; Erkuran, Burak; Akgür, Alper; Siliv, Neslihan

doi:10.1016/j.ajem.2014.12.032

Cited by 26 publications

(27 citation statements)

References 30 publications

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“…7 Seventy-four elderly adults (mean age of 72.8 years), who presented to the ED during the study time window, met inclusion criteria. Patients with severe tricuspid regurgitation, cardiac tamponade, aortic dissection, abdominal surgery within the preceding 2 weeks, or patients who had cardiopulmonary arrest, been intubated or were pregnant were excluded.…”

Section: Summary Of the Evidencementioning

confidence: 99%

“…This study concluded that US IVC measurements were “rapid, readily available, inexpensive, reproducible techniques” for differentiating dyspnea due to cardiac etiology (acute heart failure) from dyspnea of pulmonary origin. 7 …”

Section: Summary Of the Evidencementioning

confidence: 99%

“…However, a minority of studies of diagnostic tests meet this standard. The four studies reported 1,5,6,7 were prospective. In three of the four, 1,5,6 there was an independent blind comparison with reference standards.…”

Section: Limitationsmentioning

confidence: 99%

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Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ

Gaskamp

Blubaugh

McCarthy

et al. 2016

Journal of Patient-Centered Research and Reviews

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Journal of Patient-Centered Research and Reviews ( JPCRR) is a peerreviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations. Recommended CitationGaskamp M, Blubaugh M, McCarthy LH, Scheid DC. Can bedside ultrasound inferior vena cava measurements accurately diagnose congestive heart failure in the emergency department? A Clin-IQ. J Patient Cent Res Rev. 2016;3:230-4 Clinical QuestionIn adults, 18 years of age and older, who present to the emergency department (ED) with dyspnea, are inferior vena cava (IVC) measurements using bedside ultrasound as accurate as B-type natriuretic peptide (BNP) levels for identifying heart failure? Brief AnswerYes. Bedside ultrasound measurement of the IVC is a highly specific and rapid tool for diagnosing heart failure in the ED setting compared with BNP. BNP costs less than bedside ultrasound but is less specific and may take up to one hour or more at a clinical juncture when rapid detection of volume overload can rule in or rule out heart failure. In the studies reviewed, the specificity of the IVC measurement was as good as, or better than, BNP values. Ultrasound IVC measurements may be especially useful for cases in which BNP values fall into a nondiagnostic "gray zone" range. Based on current evidence, it seems reasonable to conclude that ultrasound IVC measurements, taken by properly trained ED clinicians, alone or in combination with BNP, would likely increase accuracy of diagnosing heart failure, allow earlier initiation of appropriate treatment and potentially reduce morbidity and mortality.Date of Literature Search: March/April 2016. Level of Evidence: B. Search TermsUltrasound, heart failure, inferior vena cava, pro-Btype natriuretic peptide, NR-PRoBNP, emergency department, diagnosis Inclusion CriteriaCurrent systematic reviews, meta-analyses, cohort studies, clinical research trials investigating the AbstractCongestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP also may have a "gray zone" in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of 87% and specificity of 74% at a cutoff of 400 pg/ml. Studies investigating bedside ultrasound inferior vena cava (IVC) measurements for identifying CHF report a specificity of 84% to 96% and sensitivity values ranging from 37% to 93%, depending on the study. efficacy of ultrasound measurements of the IVC for diagnosing heart failure in the ED. Exclusion CriteriaChildren less than 1...

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Section: Summary Of the Evidencementioning

confidence: 99%

Section: Summary Of the Evidencementioning

confidence: 99%

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Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ

Gaskamp

Blubaugh

McCarthy

et al. 2016

Journal of Patient-Centered Research and Reviews

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“…El diámetro y el grado de colapsabilidad en inspiración de la VCI se relaciona con bastante exactitud con la presión venosa central (Figura 12). Esto permite al clínico hacer una estimación de la volemia y, por otra parte, también se relaciona con el grado de hipertensión pulmonar 10 . La valoración de la VCI tiene una gran importancia para estimar la afectación de cavidades derechas en enfermos con cardiopatía izquierda y, como veremos más adelante, para valorar la posibilidad de taponamiento cardiaco y de embolia de pulmón.…”

Section: 2 2 Estimación De La Presión Venosa Central (Volemia)unclassified

Utilidad de la ecografía clínica en el diagnóstico del paciente con disnea

2016

Gal. Clin.

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IntroducciónLa disnea es un síntoma frecuente. Tiene una amplia variedad de posibilidades etiológicas y no siempre resulta sencillo establecer un diagnóstico correcto, especialmente en personas ancianas, obesas o en pacientes con antecedentes de enfermedad pulmonar obstructiva crónica (EPOC). La disnea puede deberse a procesos potencialmente graves en los que un diagnóstico precoz y el inicio del tratamiento médico adecuado son muy importantes 1, 2 . El desarrollo de equipos ecográficos portátiles y de gran calidad a un precio asequible ha permitido una enorme difusión de ecografía en múltiples especialidades (medicina interna, urgencias, cuidados intensivos, anestesia, reumatología, neumología, etc. ). La ecografía clínica, es decir, la realizada por el médico directamente responsable del paciente a pie de cama facilita el diagnóstico precoz del enfermo con disnea en múltiples ámbitos (urgencias, planta de hospitalización, unidades de cuidados intensivos y reanimación), incluido el medio extrahospitalario 3 . Etiología de la disneaEn la tabla 1 mostramos las causas más frecuentes de disnea. En la mayoría de los casos la disnea está relacionada con patología respiratoria o cardiaca, aunque existen diagnósticos alternativos. A pesar de una correcta valoración clínica inicial, en un porcentaje significativo de pacientes no se puede establecer con exactitud la etiología de la disnea y existen al menos dos o más posibilidades diagnósticas. De esta forma surge el concepto de "disnea indiferenciada" (tabla 2) 2 . Un reto diagnóstico, por ejemplo, es la agudización del enfermo con EPOC que puede ser debida a múltiples circunstancias (infección respiratoria, embolia de pulmón, neumotórax, insuficiencia cardiaca, cáncer de pulmón). Evaluación diagnóstica del paciente con disneaLa base del diagnóstico del enfermo con disnea se sustenta en la historia clínica y exploración física. Dependiendo de la valoración clínica inicial se solicitan, si es necesario, pruebas complementarias para esclarecer su etiología. Entre las Correspondencia:

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“…FCU of the inferior vena cava (IVC) has proven useful in the diagnosis of heart failure [12–19]. We sought to determine if FCU of the IVC during hospitalization for heart failure could be used to predict risk of hospital readmission.…”

Section: Introductionmentioning

confidence: 99%

Focused cardiac ultrasound as a predictor of readmission in acute decompensated heart failure

Laffin

Patel

Saha

et al. 2018

Int J Cardiovasc Imaging

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Acute decompensated heart failure (ADHF) is a common reason for admission to the hospital, and readmission is frequent. Multiple factors contribute to rehospitalizations, but inadequate assessment of volume status leading to persistent congestion is an important factor. We sought to determine if focused cardiac ultrasound (FCU) of the inferior vena cava (IVC), as a surrogate of volume status, would predict readmission of ADHF patients after index hospitalization. Patients admitted with a primary diagnosis of ADHF were prospectively enrolled. All patients underwent FCU of the IVC on admission and then daily. 82 patients were enrolled. Patients demonstrated improvement in heart failure physical examination findings and symptoms during the hospitalization. There was a reduction in the size of the IVC and a significant increase in patients with small collapsible vena cava. Logistic regression analysis of physical examination, patient symptoms, and IVC parameters at discharge demonstrated IVC collapsibility and patient reported dyspnea improvement as the only significant variables to predict readmission or emergency department visit. FCU assessment of IVC size and collapsibility may be useful in patients with ADHF to predict risk of being readmitted within 30 days of hospital discharge.

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The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients; best sonographic measurement method?

Cited by 26 publications

References 30 publications

Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ

Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ

Utilidad de la ecografía clínica en el diagnóstico del paciente con disnea

Focused cardiac ultrasound as a predictor of readmission in acute decompensated heart failure

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