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Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
Inferior vena cava collapsibility index, renal dysfunction, and adverse outcomes in patients with broad spectrum
Yong-Hyun Kim1, Sunwon Kim1, Jin-Seok Kim1
1Cardiovascular Division, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Korea.
Insights
A low inferior vena cava collapsibility index (IVCCI) indicates reduced renal function and predicts adverse cardiovascular outcomes. This finding is crucial for managing patients with cardiovascular diseases.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- The clinical significance of the inferior vena cava collapsibility index (IVCCI) in patients with diverse cardiovascular diseases remains underexplored.
- Assessing systemic intravascular volume status is critical for managing cardiovascular conditions.
Purpose of the Study:
- To evaluate the clinical implications of IVCCI in patients with various cardiovascular diseases.
- To determine the association between IVCCI, renal function, and patient outcomes.
Main Methods:
- The study analyzed 1166 patients, categorizing them by IVCCI levels (high, intermediate, low).
- Relationships between clinical characteristics, echocardiographic indicators (IVCCI, E/Em), and serum creatinine were assessed.
- Patient outcomes, including all-cause and cardiovascular mortality, were compared across IVCCI groups during follow-up.
Main Results:
- Lower IVCCI levels correlated with higher serum creatinine, indicating reduced renal function.
- A low IVCCI was independently associated with increased all-cause mortality (HR=3.193) and cardiovascular mortality (HR=4.428).
- Factors like age, BMI, heart failure, and serum creatinine also predicted adverse outcomes.
Conclusions:
- A low IVCCI is a significant predictor of impaired renal function in cardiovascular patients.
- Reduced IVCCI independently forecasts adverse outcomes, including mortality, irrespective of underlying cardiovascular disease or renal status.
Aims:
The clinical implication of the inferior vena cava collapsibility index (IVCCI) has not been well evaluated in patients with various cardiovascular diseases.
Method And Results:
The relationships between clinical characteristics and echocardiographic indicators of the systemic intravascular volume status [IVCCI; the ratio of the early transmitral and early myocardial diastolic velocities (E/Em)] were evaluated at baseline, and the clinical status during follow-up was compared across the IVCCI levels. Among 1166 patients (mean age=63.8±13.4 years), 934, 171, and 61 had high (≥50%), intermediate (25%-50%), and low (<25%) IVCCIs, respectively. Age-, sex-, and body mass index-adjusted serum creatinine (sCr) levels were highest in patients with low IVCCI (P=.002) and E/Em >15 (P<.001). During follow-up (1108±463 days), 67 patients died, and 38 of these deaths were cardiovascular related. Age, body mass index, heart failure (HF), sCr levels, and a low IVCCI (vs high IVCCI: hazard ratio [HR]=3.193, 95% confidence interval [CI]=1.297-7.857, P=.012) were associated with all-cause mortality in multivariable analysis. HF, diuretic use, and a low IVCCI (vs high IVCCI: HR=4.428, 95% CI=1.406-13.104, P=.007) were significantly associated with cardiovascular mortality.
Conclusion:
A low IVCCI was significantly associated with reduced renal function and was an independent risk factor for adverse outcomes, regardless of underlying cardiovascular disease and renal function.
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