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

Curbelo, José; Aguilera, Maria; Rodríguez-Cortés, Pablo; Gil-Martínez, P.; Fernández, Carmen Suárez

doi:10.1002/clc.22915

Cited by 13 publications

(14 citation statements)

References 39 publications

(87 reference statements)

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“…In particular low caval index has high specificity for the diagnosis of HF, in line with our analysis related to eRAP>15 mmHg. NT-ProBNP and IVC collapsibility are strongly and independently associated with AHF, demonstrating that fluid overload and ventricular stretching are the main pathophysiological determinant of AHF [15].…”

Section: Discussionmentioning

confidence: 98%

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

Sforza

Carlino

Guarino

et al. 2020

Monaldi Arch Chest Dis

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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.

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Section: Discussionmentioning

confidence: 98%

“…In patients with chronic heart failure (CHF) IVC diameter and collapsibility have strong correlation with volume status, natriuretic peptide and give important prognostic information [15,16]. Thus when the cause of acute dyspnea is decompensation of CHF IVC diameter can be useful for diagnostic and therapeutic approach [17,18].…”

Section: Discussionmentioning

confidence: 99%

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

Sforza

Carlino

Guarino

et al. 2020

Monaldi Arch Chest Dis

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“…However, studies conducted in patients undergoing cardiac catheterisation have only found modest correlations between right atrial pressure and IVC diameter measured by echocardiography 17 ; these relations are even weaker in those who are mechanically ventilated ( Table 1 ). 10,17–55 …”

Section: Inferior Vena Cava Ultrasoundmentioning

confidence: 99%

Ultrasound imaging of congestion in heart failure: examinations beyond the heart

Pellicori

Platz

Dauw

et al. 2020

European J of Heart Fail

110

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Congestion, related to pressure and/or fluid overload, plays a central role in the pathophysiology, presentation and prognosis of heart failure and is an important therapeutic target. While symptoms and physical signs of fluid overload are required to make a clinical diagnosis of heart failure, they lack both sensitivity and specificity, which might lead to diagnostic delay and uncertainty. Over the last decades, new ultrasound methods for the detection of elevated intracardiac pressures and/or fluid overload have been developed that are more sensitive and specific, thereby enabling earlier and more accurate diagnosis and facilitating treatment strategies. Accordingly, we considered that a state‐of‐the‐art review of ultrasound methods for the detection and quantification of congestion was timely, including imaging of the heart, lungs (B‐lines), kidneys (intrarenal venous flow), and venous system (inferior vena cava and internal jugular vein diameter).

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“…Moreover, an extensive literature indicates that the echocardiographic evaluation of IVC offers diagnostic and prognostic cues per se , regardless of which value is assigned to eRAP IVC . Demonstration of a dilated and/or non-collapsible IVC may be sufficient to identify patients with HF and increased LV filling pressures ( 29 ) and has been associated with HF hospitalization and mortality ( 19 , 30 , 31 ). In addition, a larger IVC size at discharge was related to a higher risk of readmission after a first hospitalization for HF ( 32 , 33 ).…”

Section: Discussionmentioning

confidence: 99%

Multiparametric vs. Inferior Vena Cava–Based Estimation of Right Atrial Pressure

Toma

Giovinazzo

Masoero

et al. 2021

Front. Cardiovasc. Med.

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Background: Right atrial pressure (RAP) can be estimated by echocardiography from inferior vena cava diameter and collapsibility (eRAPIVC), tricuspid E/e′ ratio (eRAPE/e′), or hepatic vein flow (eRAPHV). The mean of these estimates (eRAPmean) might be more accurate than single assessments.Methods and Results: eRAPIVC, eRAPE/e′, eRAPHV (categorized in 5, 10, 15, or 20 mmHg), eRAPmean (continuous values) and invasive RAP (iRAP) were obtained in 43 consecutive patients undergoing right heart catheterization [median age 69 (58–75) years, 49% males]. There was a positive correlation between eRAPmean and iRAP (Spearman test r = 0.66, P < 0.001), with Bland–Altman test showing the best agreement for values <10 mmHg. There was also a trend for decreased concordance between eRAPIVC, eRAPE/e′, eRAPHV, and iRAP across the 5- to 20-mmHg categories, and iRAP was significantly different from eRAPE/e′ and eRAPHV for the 20-mmHg category (Wilcoxon signed-rank test P = 0.02 and P < 0.001, respectively). The areas under the curve in predicting iRAP were nonsignificantly better for eRAPmean than for eRAPIVC at both 5-mmHg [0.64, 95% confidence interval (CI) 0.49–0.80 vs. 0.70, 95% CI 0.53–0.87; Wald test P = 0.41] and 10-mmHg (0.76, 95% CI 0.60–0.92 vs. 0.81, 95% CI 0.67–0.96; P = 0.43) thresholds.Conclusions: Our data suggest that multiparametric eRAPmean does not provide advantage over eRAPIVC, despite being more complex and time-consuming.

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

Abstract: IVC ultrasonography is a useful tool in follow-up of patients with chronic HF, allowing identification of patients at high risk of worsening and hospitalization. However, its usefulness is not higher than that of NTproBNP.

Cited by 13 publications

References 39 publications

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

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

Ultrasound imaging of congestion in heart failure: examinations beyond the heart

Multiparametric vs. Inferior Vena Cava–Based Estimation of Right Atrial Pressure

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