Abstract
Ultrasound (US)-based measurements of the inferior vena cava (IVC) diameter are widely used to estimate right atrial pressure (RAP) in a variety of clinical settings. However, the correlation with invasively measured RAP along with the reproducibility of US-based IVC measurements is modest at best. In the present manuscript, we discuss the limitations of the current technique to estimate RAP through IVC US assessment and present a new promising tool developed by our research group, the automated IVC edge-to-edge tracking system, which has the potential to improve RAP assessment by transforming the current categorical classification (low, normal, high RAP) in a continuous and precise RAP estimation technique. Finally, we critically evaluate all the clinical settings in which this new tool could improve current practice.
Highlights
IntroductionThe inspiratory collapse of the inferior vena cava (IVC) and the measurement of its diameters during the respiratory cycle are widely used in clinical practice for right atrial pressure (RAP) estimation [2], but the correlation between RAP assessed invasively and by echocardiography, and the reproducibility of IVC assessment by ultrasound (US), are no more than modest [3,4,5,6,7]
An option to standardize the measurement of the inferior vena cava (IVC) and to make the estimation of right atrial pressure (RAP) more accurate and reproducible could be the use of a software able to automatically highlight the edges of the vessel, i.e., an “edge-tracking” technique [19]
A recent study has shown that the end expiratory IVC diameter has relevant predictive ability independent from other wellknown prognostic markers in heart failure (HF), including NTproBNP itself [36]. These findings suggest that the IVC expiratory diameter and NTproBNP could play a complementary role in prognostic HF stratification both in the preserved and reduced ejection fraction settings [42]
Summary
The inspiratory collapse of the inferior vena cava (IVC) and the measurement of its diameters during the respiratory cycle are widely used in clinical practice for RAP estimation [2], but the correlation between RAP assessed invasively and by echocardiography, and the reproducibility of IVC assessment by ultrasound (US), are no more than modest [3,4,5,6,7]. The dichotomic output of IVC-based estimates (i.e., low or high RAP) fails to represent the continuous range of RAP values that may entail important therapeutic and prognostic implications. In this manuscript, we describe solutions that might improve the reliability and reproducibility of IVC assessment by echocardiography to correctly assess.
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