Abstract
Assessing hemodynamics, especially central venous pressure (CVP), is essential in heart failure (HF). Right heart catheterization (RHC) is the gold-standard, but non-invasive methods are also needed. However, the role of 2-dimensional echocardiography (2DE) remains uncertain, and 3-dimensional echocardiography (3DE) is not always available. This study investigated standardized and breathing-corrected assessment of inferior vena cava (IVC) volume using echocardiography (2DE and 3DE) versus CVP determined invasively using RHC. Sixty consecutive HF patients were included (82% male, age 54 ± 11 years, New York Heart Association class 2.23 ± 0.8, ejection fraction 46 ± 18.4%, brain natriuretic peptide 696.93 ± 773.53 pg/mL). All patients underwent Swan-Ganz RHC followed by 2DE and 3DE, and IVC volume assessment. On 2DE, mean IVC size was 18.3 ± 5.5 mm and 13.8 ± 6 mm in the largest deflection and shortest distention, respectively. Mean CVP from RHC was 9.3 ± 5.3 mmHg. Neither 2DE nor 3DE showed acceptable correlation with invasively measured CVP; IVC volume acquisition showed optimal correlation with RHC CVP (0.64; 95% confidence interval 0.46–0.77), with better correlation when mitral valve early diastole E wave and right ventricular end-diastolic diameter were added. Using a CVP cut-point of 10 mmHg, receiver operating characteristic curve showed true positivity (specificity) of 0.90 and sensitivity of 62% for predicting CVP. A validation study confirmed these findings and verified the high predictive value of IVC volume assessment. Neither 2DE nor 3DE alone can reliably mirror CVP, but IVC volume acquisition using echocardiography allows non-invasive and adequate approximation of CVP. Correlation with invasively measured pressure was strongest when CVP is > 10 mmHg.
Highlights
Heart failure (HF) prevalence is increasing, with a progressive disease course, poor prognosis and impaired quality of life [1]
central venous pressure (CVP) has been shown to be an independent predictor of cardiac rehospitalization in patients with acute decompensated HF presenting to an emergency room [3]
Due to the high clinical impact and importance of accurate CVP measurement for determining prognosis, guiding HF therapy, preventing secondary organ damage, and evaluating suitability for heart transplantation, this study investigated the best possible approach for ultrasound-based non-invasive CVP measurements using echocardiography compared with Right heart catheterization (RHC), including relevant confounders
Summary
Heart failure (HF) prevalence is increasing, with a progressive disease course, poor prognosis and impaired quality of life [1]. Guiding therapy in individual HF patients remains challenging, and hemodynamics and filling pressures play a major role, in predicting rehospitalization and mortality [2]. Assessing hemodynamic parameters, including central venous pressure (CVP), is essential in HF for both diagnostics and therapy guidance, but there is currently no non-invasive, quick, and easy-to-use technique for reliable measurement of CVP. CVP has been shown to be an independent predictor of cardiac rehospitalization in patients with acute decompensated HF presenting to an emergency room [3]. Volume overload represents the leading cause of HF decompensation. [4], but simple and reliable methods for determining volume overload in HF are lacking [5]. Established clinical appraisal of venous congestion, such as jugular vein distension is known to be unreliable and differs between observers [5, 6], venous congestion has been demonstrated to be the leading predictor of organ injury and death [7]
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