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Coronary sinus diameter to estimate congestion and predict survival
Agatella Barchitta1, Giacomo Rossitto1,2, Luisa Ruzza1
1University of Padova, Emergency Medicine and Hypertension, University Hospital, Padova, Italy.
Insights
Persistent coronary sinus dilation after hemodialysis indicates residual congestion and predicts mortality in end-stage chronic kidney disease patients. This finding aids in assessing prognosis and guiding treatment for high-risk individuals.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Congestion is a poor prognostic indicator, but its clinical assessment is difficult.
- A multiparametric approach is needed for accurate congestion evaluation.
- This study explores coronary sinus (CS) diameter as a predictor of mortality during fluid unloading.
Purpose of the Study:
- To investigate if coronary sinus (CS) diameter can predict mortality in patients undergoing rapid fluid unloading.
- To assess the utility of CS diameter in identifying congestion compared to the inferior vena cava (IVC).
Main Methods:
- Echocardiography was used to measure CS and IVC diameters in 60 end-stage chronic kidney disease (ESKD) patients before and after hemodialysis (HD).
- Patients were followed prospectively for all-cause mortality.
- Congestion was defined as pre-hemodialysis status.
Main Results:
- Hemodialysis-induced decongestion significantly reduced both CS and IVC diameters.
- CS maximum diameter (CSmax) demonstrated accuracy comparable to IVC diameter and collapsibility in identifying congestion.
- A post-hemodialysis CSmax diameter greater than 9 mm was a significant predictor of 12-month all-cause mortality.
Conclusions:
- A persistently dilated CS after hemodialysis serves as a marker for residual congestion.
- This finding predicts mortality at one year in high-risk ESKD patients.
- CS diameter measurement offers a valuable tool for prognostication in ESKD patients.
Background:
Congestion predicts a poor prognosis, but its assessment is challenging in clinical practice and requires a multiparametric approach. We investigated if the coronary sinus (CS) diameter can predict mortality in a human model of rapid fluid unloading.
Methods:
We measured by echocardiography the CS, and the inferior vena cava (IVC) for comparison, in 60 patients with end-stage chronic kidney disease (ESKD) immediately before and after hemodialysis (HD; age 76 [57-81] years, 40% female, left ventricular ejection fraction 57 [53-56]%). Patients were prospectively followed up for all-cause mortality.
Results:
HD-induced decongestion decreased the maximum diameters of both CS and IVC (p ≤ 0.001 for all). The maximum diameter of the CS (CSmax) was as accurate as the IVC maximum diameter and collapsibility for the identification of congestion, defined as pre-hemodialysis status (AUROC CSmax = 0.902 vs IVC = 0.895, p = n.s.). A CSmax diameter after hemodialysis > 9 mm predicted all-cause mortality at 12 months (Log-rank Chi square = 11.49, p < 0.001).
Conclusions:
A persistently dilated CS after hemodialysis is a marker of residual congestion and predicts death at one year in high-risk ESKD patients.
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