A dilated inferior vena cava is a marker of poor survival

The inferior vena cava (IVC) morphology is often used to estimate right atrial pressure; however, the association of IVC morphology and outcome is poorly described.

We evaluated 4383 consecutive outpatients (98% men) undergoing echocardiography at 1 of 3 Veterans Affairs laboratories.

Of the 3729 with adequate images, 3295 (88%) had a normal IVC (< 2 cm), 358 (10%) had a dilated IVC that collapsed at least 50% with inspiration, and 76 (2%) had dilated IVC that did not collapse. Compared with patients with a normal IVC, those with a dilated IVC were older (66 +/- 13 vs 69 +/- 12 years if dilated with collapse and 70 +/- 12 years if dilated without collapse, P = .0005) and were more likely to have a history of heart failure (11% vs 18% if dilated with collapse and 38% if dilated without collapse, P < .0001). The 90-day and 1-year survival rates were 99% and 95% for those with a normal IVC, 98% and 91% for those with a dilated IVC with collapse, and 89% and 67% for those with a dilated IVC without collapse (P < .0001). After adjustment for clinical and echocardiographic characteristics including left and right ventricular function and pulmonary artery pressure, a dilated IVC without collapse remained associated with increased mortality: hazard ratio 1.43 (1.29-1.57 compared with a normal IVC, P < .0001).

A dilated IVC without collapse with inspiration is associated with worse survival in men independent of a history of heart failure, other comorbidities, ventricular function, and pulmonary artery pressure.