Inferior Vena Cava Ultrasound for Decongestion Assessment in Acute Heart Failure: Systematic Review

Area of Science:

• Cardiology
• Critical Care Medicine
• Medical Imaging

Background:

• Residual congestion at discharge in acute heart failure (AHF) is a significant predictor of readmission and mortality.
• Inferior vena cava (IVC) ultrasound offers a noninvasive method to assess volume status at the bedside.
• The clinical utility of IVC ultrasound in guiding AHF decongestion therapy requires further definition.

Purpose of the Study:

• To systematically evaluate the efficacy of Inferior Vena Cava (IVC) ultrasound-guided therapy versus standard clinical assessment for decongestion in acute heart failure (AHF).
• To compare key clinical outcomes and markers of congestion between IVC ultrasound-guided and standard care groups in AHF patients.

Main Methods:

• A systematic review adhering to PRISMA guidelines was conducted, searching major databases through October 2025.
• Included studies comprised randomized controlled trials (RCTs) and nonrandomized studies involving adults with AHF managed with IVC ultrasound.
• Primary outcomes assessed included congestion markers, NT-proBNP levels, duration of hospitalization, and mortality rates.

Main Results:

• Four studies with 629 patients indicated improved decongestion with IVC ultrasound guidance, showing reduced residual congestion and better IVC metrics.
• While NT-proBNP levels decreased across all groups, statistically significant between-group differences were not observed.
• Clinical outcomes improved in 50% of studies, with shorter hospital stays and reduced mortality noted; one trial showed a significant mortality benefit (3.3% vs. 33.3%; p = 0.003). Adverse events were similar or fewer in the ultrasound-guided groups.

Conclusions:

• Inferior vena cava (IVC) ultrasound serves as an effective bedside tool for personalized volume management in acute heart failure (AHF).
• This approach shows potential for enhancing treatment precision and improving clinical outcomes in AHF patients.
• Larger multicenter trials are warranted to establish standardized implementation protocols for IVC ultrasound in routine heart failure care.