Prognostic Significance of Inferior Vena Caval Diameter in Patients with Chronic Heart Failure

Heart failure is a major public health problem with rising prevalence and accounts for a substantial number of OPD and emergency visits. Despite advances in pharmacotherapy and various devices being added to the armamentarium in managing heart failure the mortality continue to remain high. Therefore, we seek to find an easy bedside tool for risk stratification and prognostication of patients suffering from chronic heart failure for identifying patients with high risk and tailoring appropriate therapy for better outcome.

Consecutive patients, clinically diagnosed as heart failure supported by objective evidence of cardiac dysfunction: either a LVEF 45% or LA dilatation, or both was studied to find out the etiologies, symptoms and signs, derangement of laboratory parameters and echocardiographic findings including IVC diameter and was followed up for six months at monthly intervals.

A prospective observational study was performed on 62 patients. Majority of heart failure occurred in the age group of 51 to 60 years. Acute coronary events, infections, arrhythmias were the commonest precipitating factors. An increase in LVIDD, LA diameter, LA volume index was significantly associated with increase in mortality (p=0.002, p=0.034, p=0.011 respectively. An increase in IVC diameter was found to be significantly associated with increased mortality (P=0.001).

In a country with limited resources like India, inferior vena caval diameter, as a surrogate marker of congestion, may prove to be a cost effective way in predicting and prognosticating patients with heart failure.