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[Correlation between the inferior vena cava collapsibility and asymptomatic pericardial effusion in hemodialysis
Natasa S Marković1, Nada Dimković, Tatjana Damjanović
1Klinicko bolnicki centar Zvezdara, Beograd. natmarkovic@yahoo.com
Insights
In hemodialysis patients, asymptomatic pericardial effusion is linked to a lower inferior vena cava collapsibility index, indicating hypervolemia and poor left ventricular function. This effusion portends a worse prognosis.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- The inferior vena cava collapsibility index is a key indicator of hypervolemia in patients undergoing hemodialysis.
- Asymptomatic pericardial effusion in this population can signify hypervolemia, impaired left ventricular systolic function, or both.
- This study aimed to determine the incidence of asymptomatic pericardial effusion and its relationship with the collapsibility index in hemodialysis patients over a two-year period.
Purpose of the Study:
- To assess the incidence of asymptomatic pericardial effusion in hemodialysis patients.
- To evaluate the correlation between asymptomatic pericardial effusion and the inferior vena cava collapsibility index.
- To investigate the prognostic implications of asymptomatic pericardial effusion in this cohort.
Main Methods:
- A prospective study involving 115 consecutive hemodialysis patients.
- Regular clinical assessments, ECG, echocardiography, and laboratory tests were performed every six months over a two-year follow-up.
- Statistical analysis was used to compare groups and assess correlations.
Main Results:
- 29.21% of patients (29 out of 115) developed asymptomatic pericardial effusion.
- Patients with asymptomatic pericardial effusion had a significantly lower collapsibility index (0.39±0.09) compared to those without (0.69±0.21; p<0.001).
- Asymptomatic pericardial effusion showed inverse correlations with the collapsibility index and left ventricular ejection fraction, and a positive correlation with left ventricular end-diastolic dimension. Persistent effusion and systolic dysfunction were associated with increased mortality risk.
Conclusions:
- The collapsibility index and asymptomatic pericardial effusion are inversely correlated and both serve as indicators of hypervolemia.
- Asymptomatic pericardial effusion in hemodialysis patients is also indicative of impaired left ventricular systolic function and is associated with a poor prognosis.
Introduction:
The inferior vena cava collapsibility index is a sign of hypervolemia in hemodialysis patients. Asymptomatic pericardial effusion in these patients can be either a sign of hypervolemia or bad systolic function of the left ventricle, or both. The aim of this study was to assess the incidence of asymptomatic pericardial effusion and its correlation to collapsibility index in haemodialysis patients during 2-year follow-up.
Results:
Of 115 consecutive hemodialysis patients, at the beginning of the study and on every 6 months we performed: clinical, ECG, echocardiography, laboratory assessment. There was 29 patients with asymptomatic pericardial effusion (25.21%) vs. 86 (74.79%) without asymptomatic pericardial effusion. There was no significant difference considering gender, age, vintage of HD between the groups. Colapsibillity index was statistically significantly lower among the patients with asymptomatic pericardial effusion: 0.39+/-0.09 vs. 0.69+/-0.21 in those without it; p<0.001. Asymptomatic pericardial effusion correlated inversely with colapsibillity index (r=-0.577; p<0.0001) and ejection fraction of left ventricle (r=-0.282; p<0.030) and positively with the dimension of left ventricle in diastole. The colapsibillity index had inverse correlation with asymptomatic pericardial effusion (r=-0.668; p<0.0001), end-diastolic dimension of the left ventricle (r=-0.464; p<0.0001), and only one positive correlation with Kt/V (r=0.294, p<0.002). During the follow-up, 16 pts (13.91%) died: 7 of them had a symptomatic pericardial effusion (43.75%). Factors with greatest relative risk for death were: persistent asymptomatic pericardial effusion (3.48); systolic dysfunction at the second examination (2.95): heart failure (2.88) at the third.
Conclusion:
Colapsibillity index and asymptomatic pericardial effusion are the closely correlated in inverse manner and both are the sign of hypervolemia. Asymptomatic pericardial effusion is also a sign of a bad systolic function and a very bad prognosis.
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