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Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
Inferior Vena Cava Ultrasound Does Not Reliably Estimate Systemic Venous Pressure in Adults With a Fontan Circulation
Jef Van den Eynde1,2, Hannah Van Belle1,2, Jan Bogaert3,4
1Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
Echocardiography guidelines for estimating central venous pressure using the inferior vena cava (IVC) are unreliable in adults with Fontan circulation. Direct pressure measurements are recommended for accurate assessment in this patient group.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Vascular Physiology
Background:
- Current echocardiography guidelines recommend estimating central venous pressure (CVP) using inferior vena cava (IVC) diameter and collapsibility.
- The reliability of these criteria in Fontan circulation, which involves altered hemodynamics, remains uncertain.
Purpose of the Study:
- To evaluate the accuracy of current ASE/EACVI echocardiography guidelines for estimating central venous pressure in adults with Fontan circulation.
- To assess if recalibrating IVC diameter and collapsibility thresholds can improve pressure estimation accuracy.
Main Methods:
- Simultaneous echocardiographic measurement of IVC and peripheral venous pressure (PVP) in 101 adults with Fontan circulation.
- Application of standard ASE/EACVI criteria (IVC diameter > 21 mm, collapsibility < 50%) and assessment of agreement with measured PVP.
- Post hoc analysis to optimize IVC diameter and collapsibility thresholds within the cohort.
Main Results:
- Inferior vena cava (IVC) diameter and collapsibility did not correlate with peripheral venous pressure (PVP).
- Conventional criteria showed poor agreement with measured PVP (weighted κ = 0.02).
- Optimized thresholds (IVC diameter ≥ 20 mm, collapsibility ≤ 10%) only modestly improved agreement (weighted κ = 0.24).
Conclusions:
- Inferior vena cava (IVC)-based pressure estimation is unreliable in adults with Fontan circulation.
- Validated peripheral or invasive pressure measurements are preferred for accurate Fontan pressure assessment.
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