Utilization of Ultrasound to Assess Volume Status in Heart Failure.

Abstract

Heart failure (HF) represents a significant financial burden to the US health care system, affecting approximately 5.7 million Americans. By 2030, the prevalence of HF is expected to increase by 23%. Clinicians generally evaluate volume status in patients with HF by visualizing jugular venous distension to estimate right atrial pressure; a method with an estimated accuracy of only 50%. Currently, the only endorsed methods for acute HF diagnosis in the 2017 American College of Cardiology (ACC) guidelines are brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP), pre-discharge BNP or NT-proBNP, and myocardial fibrosis markers. However, serial testing of BNP to monitor therapy remains controversial. Moreover, an elevated BNP cannot be attributed solely to a cardiac cause. Given the limitations of the current methods, a robust tool is needed to reliably assess volume status in HF patients. It is now known that hemodynamic congestion from increases in intracardiac pressure occurs days to weeks prior to the onset of typical HF symptoms, such as weight gain and shortness of breath. It has been postulated that assessing the inferior vena cava (IVC) diameter with a portable ultrasound, may be the simple, reliable, and cost-effective method of evaluating right atrial pressure, and thus, the severity of HF. Given this exciting new tool in assessing volume status in patients with HF, we pose the question of whether this imaging modality can be used to risk-stratify patients and guide management. The aim of this paper is to highlight the many benefits of portable ultrasound in assessing volume status in this population, and to discuss whether this imaging modality can help guide physicians in the management of their HF patients.