Ultrasound diagnosis of congestion in the pulmonary and systemic circulations in patients with atrial fibrillation and chronic heart failure

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Rationale — Fluid retention is among the most common causes of heart failure decompensation. The goal of our study was to evaluate the sensitivity and specificity of the ultrasound method for evaluating congestive phenomena in both systemic and pulmonary circulatory systems in patients with atrial fibrillation (AF) and chronic heart failure (CHF). Material and Methods — The study included 28 patients with paroxysmal AF, with or without CHF, who were scheduled for radiofrequency pulmonary vein isolation. The maximum and minimum diameters of the right superior pulmonary vein (RSPV) and inferior vena cava (IVC) were measured via echocardiography on expiration. Mean blood pressure in both right and left atria was measured intraoperatively. We calculated the correlations between maximum and minimum diameters of the RSPV and a mean pressure in the left atrium, as well as between IVC on expiration and a mean pressure in the right atrium, and evaluated the sensitivity and specificity of ultrasound diagnostics for evaluating congestive phenomena in both systemic and pulmonary circulation. Results — We established positive correlation between the minimum diameter of RSPV and invasively measured mean left atrial pressure (R=0.65, P<0.05), and between invasively measured mean right atrial pressure and IVC diameter on expiration (R=0.49, P<0.05). The proposed method sensitivity for detecting pulmonary venous hypertension (PVH) on the basis of the maximum RSPV diameter ≥21.7 mm was 75%, and the specificity was 86%. The sensitivity and specificity for detecting PVH on the basis of the minimum RSPV diameter ≥10.5 mm constituted 85% and 86%, respectively. When using the IVC diameter on expiration ≥18.5 mm as an indicator, the sensitivity and specificity for detecting PVH were evaluated at the levels of 100% and 92%, correspondingly. Conclusion — The proposed ultrasound method of diagnosing congestion in pulmonary circulation via maximum and/or minimum diameter of the RSPV can be effectively employed in clinical practice in the same way as conventional technique of congestion diagnostics in systemic circulation via the diameter of IVC in patients with atrial fibrillation and chronic heart failure.