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Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
IVC diameter in patients with chronic heart failure: relationships and prognostic significance
Pierpaolo Pellicori1, Valentina Carubelli, Jufen Zhang
1Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, United Kingdom. pierpaolo.pellicori@hey.nhs.uk
Insights
In chronic heart failure (HF) patients, a larger inferior vena cava (IVC) diameter indicates a higher risk of adverse outcomes, independent of other clinical factors. This finding aids in predicting prognosis for heart failure patients.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Imaging
Background:
- The inferior vena cava (IVC) diameter reflects right atrial pressure, potentially serving as an independent marker of heart failure (HF) severity.
- Previous research has not fully explored the relationship between IVC diameter, clinical variables, and prognostic significance in HF patients.
Purpose of the Study:
- To investigate the association between IVC diameter and clinical characteristics.
- To determine the prognostic value of IVC diameter in patients with chronic heart failure (HF).
Main Methods:
- A cohort of 693 outpatients with chronic HF was enrolled between 2008 and 2010.
- HF was diagnosed based on symptoms, signs, and objective cardiac dysfunction (LVEF <45% or left atrial dilation with elevated NT-proBNP).
- Patients were followed for a composite endpoint of cardiovascular death and HF hospitalization.
Main Results:
- Patients in the highest tertile of IVC diameter were older, had lower BMI, higher prevalence of atrial fibrillation, and received more diuretics.
- Increased IVC diameter correlated with higher left atrial volumes, pulmonary pressures, and NT-proBNP levels.
- Multivariable analysis revealed that increasing IVC diameter, urea, and trans-tricuspid systolic gradient independently predicted poor outcomes, while LVEF and global longitudinal strain did not.
Conclusions:
- Increasing IVC diameter is a significant independent predictor of adverse outcomes in patients with chronic heart failure.
- This measurement provides valuable prognostic information, particularly in patients with or without reduced left ventricular ejection fraction (LVEF).
Objectives:
The aim of this study was to assess the relation between inferior vena cava (IVC) diameter, clinical variables, and outcome in patients with chronic heart failure (HF).
Background:
The IVC distends as right atrial pressure rises. Therefore it might represent an index of HF severity independent of left ventricular ejection fraction (LVEF). The relation between IVC diameter and other clinical variables and its prognostic significance in patients with HF has not been explored.
Methods:
Outpatients attending a community HF service between 2008 and 2010 were enrolled. Heart failure was defined as the presence of relevant symptoms and signs and objective evidence of cardiac dysfunction: either LVEF <45% or the combination of both left atrial dilation (≥4 cm) and raised amino-terminal pro-brain natriuretic peptide (NT-proBNP) ≥400 pg/ml. Patients were followed for a median of 567 (interquartile range: 413 to 736) days. The primary composite endpoint was cardiovascular death and HF hospitalization.
Results:
Among the 693 patients enrolled, median age was 73 years, 33% were women, and 568 had HF. Patients with HF in the highest tertile of IVC diameter were older; had lower body mass index; were more likely to have atrial fibrillation and to be treated with diuretics; and had larger left atrial volumes, higher pulmonary pressures, and less negative values for global longitudinal strain. The LVEF and systolic blood pressure were similar across tertiles of IVC diameter. The IVC diameter and log [NT-proBNP] were correlated (r = 0.55, p < 0.001). During follow-up, 158 patients reached a primary endpoint. In a multivariable Cox regression model, including NT-proBNP, only increasing IVC diameter, urea, and the trans-tricuspid systolic gradient independently predicted a poor outcome. Neither global longitudinal strain nor LVEF were adverse predictors.
Conclusions:
In patients with chronic HF with or without a reduced LVEF, increasing IVC diameter identifies patients with an adverse outcome.
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