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Published on: January 13, 2023
Prognostic role of inferior vena collapsibility index in congenital heart disease: A validation study
Alexander C Egbe1, Omar Abozied1, William R Miranda1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America.
Insights
The inferior vena cava collapsibility index (IVCCI) <60% better predicts cardiovascular events in adults with congenital heart disease (CHD) than the American Society of Echocardiogram (ASE) criteria. This finding improves risk stratification for CHD patients.
Area of Science:
- Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Previous studies suggest Inferior Vena Cava Collapsibility Index (IVCCI) <60% may outperform American Society of Echocardiogram (ASE) criteria for estimating right atrial pressure (RAP).
- Prior research was limited to selected adult congenital heart disease (CHD) cohorts, restricting generalizability.
Purpose of the Study:
- To validate the prognostic performance of IVCCI in a broader, more representative sample of adults with CHD.
- To enhance the generalizability of IVCCI's prognostic value in CHD patients.
Main Methods:
- Retrospective cohort study of 4029 adults with CHD undergoing echocardiography (2003-2021).
- Elevated right atrial pressure (RAP) defined as >10 mmHg, assessed by IVCCI <60% or ASE criteria (IVC diameter <2.1 cm and IVCCI <50%).
- Cardiovascular events included heart failure hospitalization, transplant, or death.
Main Results:
- Elevated RAP identified in 19% by IVCCI <60% vs. 15% by ASE criteria.
- A total of 374 (9%) patients experienced cardiovascular events during follow-up.
- IVCCI <60% independently predicted cardiovascular events (aHR 2.08) and showed superior prognostic performance over ASE criteria (C-statistic difference 0.036, P=0.008).
Conclusions:
- The Inferior Vena Cava Collapsibility Index (IVCCI) demonstrates superior prognostic performance compared to the American Society of Echocardiogram (ASE) criteria in adults with congenital heart disease.
- IVCCI <60% is a valuable tool for predicting cardiovascular events in this population.
Background:
A recent study showed that inferior vena cava collapsibility index (IVCCI) <60% had better prognostic performance as compared to the American Society of Echocardiogram (ASE) criteria for estimating right atrial pressure (RAP). However, this study was based on a selected cohort of adults with congenital heart disease (CHD) that underwent right heart catheterization and limiting the generalizability of the results. The purpose of this study was, therefore, to validate the prognostic performance of IVCCI in a more representative sample of adults with CHD, which would in turn, improve generalizability of the results.
Methods:
Retrospective cohort study of adults with CHD that underwent echocardiogram at Mayo Clinic (2003-2021). Elevated RAP was defined as RAP >10 mmHg, and was estimated using IVCCI <60% or the ASE criteria (maximum IVC diameter < 2.1 cm and IVCCI <50%). Cardiovascular event was defined as heart failure hospitalization, heart transplant or cardiovascular death.
Results:
Of the 4029 patients, 754 (19%) and 601 (15%) had elevated RAP (RAP >10 mmHg) based on IVCCI <60%, and the ASE criteria, respectively. Of the 4029 patients, 374 (9%) had cardiovascular events during 7.6 (4.4-10.5) years of follow-up. IVCCI <60% was independently associated with cardiovascular events (adjusted HR 2.08, 95% CI 1.75-2.42; C-statistic 0.708, 95%CI 0.688-0.728), and provided improved prognostic performance as compared to the ASE criteria (C-statistic difference 0.036, 95%CI 0.017-0.055, P = 0.008).
Conclusions:
IVCCI had superior prognostic performance as compared to the ASE criteria.
