Inferior Vena Cava Diameter Research Articles

The Efficacy of Inferior Vena Cava Diameter, Perfusion Index and Pleth Variability Index on Predicting Hypotension in Spinal Anesthesia

Objective: One of the most common side effects of spinal anesthesia (SA) is hypotension. The aim of the study was to evaluate the efficacay of inferior vena cava (IVC) diameter measurements, perfusion index (PI) and pleth variability index (PVI) values in determining the risk of developing hypotension after SA. Materials and Methods: This study was conducted on 81 patients who underwent transurethral prostatectomy. Before administration of SA, PI and PVI values, IVC diameters (IVCmin: during inspiration and IVCmax: during expiration) and IVC collapsibility index (IVCCI) values and non-invasive blood pressure were recorded. Patients with a baseline systolic arterial pressure reduction rate of ≥25% were determined as the group developing hypotension. IVC diameter measurements were measured immediately after SA then 5 min, and at the end of the operation. The heart rate, mean arterial pressure, PI and PVI values were recorded at regular intervals. Results: Hypotension occured in 32 patients (39.5%). In the hypotensive group, IVCmax and IVCmin values were observed lower and IVCCI values higher. The optimal threshold value of IVCmin was ≤0.99 and threshold value of IVCCI was >%44.5 for predicting hypotension after SA. Conclusion: While IVCmin and IVCCI values were effective in determining hypotension risk after SA, PI and PVI values were not. To predict hypotension by IVC diameter measurements after SA will allow a more effective intervention and avoid hypotension.

Influence of sex and age on inferior vena cava diameter and implications for the implantation of vena cava filters.

Measuring the venous diameter and choosing a compatible vena cava filter are essential to reduce the risk of complications resulting from implantation of these devices. However, there is little information on how the diameter of the inferior vena cava varies with sex and age. To determine the influence of patients' gender and age on their inferior vena cava diameter and the suitability of the different models of available filters. Retrospective analytical study based on computed tomography images. The diameter of the inferior vena cava was measured at 3 points: above the confluence of the common iliac veins, below the renal veins, and midway between these two points (cranial point, caudal point, and midpoint) using Arya® and Carestream PACS® software. The results were classified by sex and age groups. CT scans of 417 patients were analyzed: 245 women and 172 men. The diameters at the midpoint and caudal point were, respectively, 19.1 mm and 20.6 mm in women from 81 to 92 years old and were statistically smaller (p< 0.05) when compared to women aged 19 to 40 years (midpoint: 22.7 mm; caudal point: 23 mm). Similar results were seen in men. Venous diameters at the cranial and caudal points in patients aged from 51 to 70 years were statistically larger in men (cranial point: 24.4 mm; caudal point:22.3 mm) than in women (cranial point: 22.6 mm; caudal point:20.8 mm) (p< 0.05). A smaller diameter was found for the inferior vena cava in older patients of both sexes and the rate of diameter change was similar among men and women.

ECG in the clinical and prognostic evaluation of patients with pulmonary arterial hypertension: an underestimated value.

Background:Pulmonary arterial hypertension (PAH) is a rare disease leading to right ventricular (RV) failure and manifests in decreasing exercise tolerance. Our study aimed to assess the usefulness of electrocardiographic parameters reflecting right heart hypertrophy as predictors of clinical status in PAH.Methods:The retrospective analysis included 26 patients, mean 49 ± 17 years of age, diagnosed with PAH, and eligible to undergo cardiopulmonary exercise test (CPET). The relations between ECG values and parameters obtained in procedures such as six-minute walk test (6-MWT), echocardiography, right heart catheterization (RHC), and CPET were analyzed.Results:P-wave amplitude in lead II correlated positively with CPET parameter of respiratory response: minute ventilation to carbon dioxide production slope (VE/VCO2 slope; r = 0.436, p = 0.029) and echocardiographic estimated RA pressure (RAP; r = 0.504, p = 0.02). RV Sokolow-Lyon index (RVSLI) positively correlated with echocardiographic parameters reflecting RV function, overload, and afterload–tricuspid regurgitation pressure gradient (TRPG; r = 0.788, p < 0.001), RV free wall thickness (r = 0.738, p < 0.001), and mean pulmonary arterial pressure (mPAPECHO; r = 0.62, p = 0.0016), respectively, as well as VE/VCO2 slope (r = 0.593, p = 0.001) and mPAP assessed directly in RHC (mPAPRHC; r = 0.469, p = 0.0497). R-wave in lead aVR correlated positively with TRPG (r = 0.719, p < 0.001), mPAPECHO (r = 0.446, p = 0.033), and several hemodynamic criteria of PAH diagnosis: positively with mPAPRHC (r = 0.505, p = 0.033) and pulmonary vascular resistance (r = 0.554, p = 0.026) and negatively with pulmonary capillary wedge pressure (r = −0.646, p = 0.004). QRS duration correlated positively with estimated RAP (r = 0.589, p = 0.004), vena cava inferior diameter (r = 0.506, p = 0.016), and RA area (r = 0.679, p = 0.002) and negatively with parameters of exercise capacity: peak VO2 (r = −0.486, p = 0.012), CPET maximum load (r = − 0.439, p = 0.025), and 6-MWT distance (r = −0.430, p = 0.046). ROC curves to detect intermediate/high 1-year mortality risk (based on ESC criteria) indicate RVSLI (cut-off point: 1.57 mV, AUC: 0.771) and QRS duration (cut-off points: 0.09 s, AUC: 703 and 0.1 s, AUC: 0.759) as relevant predictors.Conclusion:Electrocardiography appears to be an important and underappreciated tool in PAH assessment. ECG corresponds with clinical parameters reflecting PAH severity.

Influência do sexo e da idade sobre o diâmetro da cava inferior e implicações para o implante de filtros de veia cava

Abstract Background Measuring the venous diameter and choosing a compatible vena cava filter are essential to reduce the risk of complications resulting from implantation of these devices. However, there is little information on how the diameter of the inferior vena cava varies with sex and age. Objectives To determine the influence of patients’ gender and age on their inferior vena cava diameter and the suitability of the different models of available filters. Methods Retrospective analytical study based on computed tomography images. The diameter of the inferior vena cava was measured at 3 points: above the confluence of the common iliac veins, below the renal veins, and midway between these two points (cranial point, caudal point, and midpoint) using Arya® and Carestream PACS® software. The results were classified by sex and age groups. Results CT scans of 417 patients were analyzed: 245 women and 172 men. The diameters at the midpoint and caudal point were, respectively, 19.1 mm and 20.6 mm in women from 81 to 92 years old and were statistically smaller (p&lt; 0.05) when compared to women aged 19 to 40 years (midpoint: 22.7 mm; caudal point: 23 mm). Similar results were seen in men. Venous diameters at the cranial and caudal points in patients aged from 51 to 70 years were statistically larger in men (cranial point: 24.4 mm; caudal point:22.3 mm) than in women (cranial point: 22.6 mm; caudal point:20.8 mm) (p&lt; 0.05). Conclusions A smaller diameter was found for the inferior vena cava in older patients of both sexes and the rate of diameter change was similar among men and women.

Inferior vena cava and pulmonary artery diameters for prognosis of Coronavirus disease

Inferior vena cava and pulmonary artery diameters for prognosis of Coronavirus disease

Preoperative Ultrasonographic Evaluation of Subclavian Vein and Inferior Vena Cava for Predicting Hypotension Associated with Induction of General Anesthesia.

Introduction:Induction of general anesthesia is often associated with hypotension and is a common scenario faced by anesthesiologists. Intraoperative hypotension can have detrimental effects and cause various adverse effects leading to an extended hospital stay. Patients' preinduction volume status can have an effect on postinduction blood pressure. Ultrasonography is a useful tool for measuring intravascular volume status. We studied the ability of ultrasonographic measurement of subclavian vein (SCV) and inferior vena cava (IVC) diameter, collapsibility index (CI) to predict hypotension after induction of general anesthesia.Materials and Methods:We included 120 patients in our study. SCV measurements during spontaneous and deep inspiration and IVC measurements were taken before induction and postinduction blood pressure was monitored. Patients with mean arterial blood pressure <60 mmHg or with a 30% decrease from baseline were considered to be having hypotension.Results:The CI of IVC with a cutoff 37% showed sensitivity of 94% and specificity of 84% which was statistically significant. The CI of 36% of SCV during deep breathing was found to have high sensitivity and specificity of 90% and 87%.Conclusion:Our study in spontaneously breathing preoperative patients shows that SCV CI in deep breathing and IVC CI is very sensitive and reliable in predicting postinduction hypotension. Bedside ultrasound measurements can be easily done to obtain valuable information to recognize patients who could be at risk from postinduction hypotension.

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

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&lt;0.05), and between invasively measured mean right atrial pressure and IVC diameter on expiration (R=0.49, P&lt;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.

Correlation of Inferior Vena Cava diameter and IVC Collapsibility Index with Central Venous Pressure (CVP) in critically ill surgical patients

Introduction: Central Venous Pressure is a valuable parameter in the management of critically ill surgical patients in the ICU. Non-invasive methods to extrapolate the volume status of the patient can aid clinicians in expediting proper treatment. The objective of this study is to find a correlation between Inferior Vena cava (IVC) diameter and collapsibility index (CI) with Central venous pressure (CVP) in critically ill surgical patients. Methods: This cross-sectional study included 60 critically ill patients from September 2020 – 31st February 2021. We recorded the patient's age, sex, heart rate, blood pressure, CVP, volume status, IVC minimum, and maximum diameter. After taking consent and explaining the procedure to the patient, the maximum IVC anteroposterior diameter was noted at the end of inspiration and end of expiration in centimeters. IVC collapsibility index was calculated using the formula ([IVCdmax-IVCdmin]/IVCdmax*100%). Following this, the CVP of the patient was measured. Results: Among the patients evaluated, 32 were females. The mean age of the participants was 44.90 ± 15.76 years. The mean central venous pressure maintained was 11.10 ± 2.11cm H2O with an inferior vena cava collapsibility index of 29.69 ± 8.75. There was a negative correlation between CVP and IVC collapsibility index (%), which was statistically significant (r = -0.701, n = 60, p &lt; 0.01). A strong positive correlation between CVP and maximum IVC diameter (r = 0.712, n = 60, p &lt; 0.01) and minimum IVC diameter (r = 0.796, n = 60, p &lt; 0.01) was found. Conclusion: Inferior Vena Cava diameter and IVC Collapsibility Index can be used as a reliable substitute to central venous pressure to determine the patient's volume status.

Factors influencing inferior vena cava diameter and its respiratory variation: Simultaneous comparison with hemodynamic data

BackgroundUltrasound assessment of inferior vena cava (IVC) diameter and its respiratory variation is widely used to estimate right atrial pressure (RAP). Generally, the IVC distends as the RAP rises; however, there may be discrepancies between the values. Therefore, it is critical to recognize clinical factors other than RAP that may influence IVC measurements. MethodsWe obtained the IVC maximum diameter and IVC collapsibility index (IVCCI) simultaneously during right-heart catheterization in 71 consecutive patients. Then, we assessed various clinical and hemodynamic factors to elucidate the independent determinants of IVC measurements. Moreover, we tried to generate the regression equation to estimate mean RAP from the IVC maximum diameter and IVCCI. ResultsThe mean IVC maximum diameter and IVCCI were 15 ± 4 mm and 51 ± 15%, respectively. In stepwise multivariate analysis, the higher mean RAP (β = 0.52; p < 0.0001), the presence of significant tricuspid regurgitation (β = 0.31; p = 0.0005), a larger body surface area (β = 0.22; p = 0.0017), and younger age (β = -0.18; p = 0.049) were independently associated with the IVC maximum diameter. Only the mean RAP was independently associated with the IVCCI (β = -0.45; p < 0.0001). The regression equation (R2 = 0.43, p < 0.0001) was as follows: estimated mean RAP = 3.7 + 0.62 × maximum IVC diameter / BSA - 0.07 × IVCCI. ConclusionDistension of the IVC mainly occurs with elevated RAP. However, the presence of significant tricuspid regurgitation, a larger body surface area, and younger age are associated with the IVC maximum diameter, independently of RAP. Interestingly, IVCCI is influenced only by RAP.

Screening for portopulmonary hypertension using computed tomography-based measurements of the main pulmonary artery and ascending aorta diameters in patients with portal hypertension.

This study aimed to demonstrate the feasibility of identifying candidates of portopulmonary hypertension (PoPH) from general portal hypertension patients based on chest computed tomography (CT) results. One hundred and thirty patients with portal hypertension who had undergone interventional radiology therapies at our hospital between August 2011 and July 2021 were included, and preoperative clinical data were collected. Suspicious PoPH was defined as main pulmonary artery diameter (mPA-D)≥29mm or the ratio of mPA-D to ascending aorta diameter (mPA-D/aAo-D)≥1.0, and probable PoPH as mPA-D≥33mm based on the chest CT. Prevalence of suspicious and probable PoPH was evaluated, and the differences in clinical characteristics of each population were compared. Overall, 29 (22.3%) and 5 (3.8%) patients were categorized as suspicious and probable PoPH, respectively. Univariate analyses revealed that female sex, higher shortest diameter of inferior vena cava, presence of portosystemic shunts ≥5mm, and lower blood urea nitrogen levels were significantly associated with suspicious PoPH (p<0.05). Multivariate analyses identified all four factors as significantly independent determinants of suspicious PoPH (p<0.05). In addition, among the population of suspicious PoPH, there were significant differences in seven parameters, including total bilirubin levels and spleen volume between patients with and without probable PoPH (p<0.05). However, no significant independent indicators of probable PoPH were found. CT-based measurements of mPA-D and mPA-D/aAo-D have the potential to screen patients with suspicious PoPH in clinical practice focused on portal hypertension.

563 Different right ventricle maladaptation in patients with HFrEF and HFpEF: diagnostic and prognostic implications

Abstract Aims The prognostic impact of right ventricular (RV) dysfunction and of pulmonary hypertension (PH) in patients affected by heart failure (HF) is well known. More recently it has been demonstrated that the coupling between the afterload and the function of the right ventricle in terms of TAPSE/PAPS ratio, may provide additional prognostic information. In contrast, sparse and conflicting data have been published regarding the relevance of different echocardiographic features in patients with reduced or preserved ejection fraction. Additionally, RV function and ventricular-arterial coupling is poorly studied in acute setting. We planned a prospective monocentric study aimed at elucidating the role of PH and of RV structure and function, assessed by means of an echocardiographic examination in the early phase of hospital admission of patients with ADHF. We also compared different echo parameters in order to assess the prognostic role in patient affected by HF and reduced ejection fraction (HFrEF) vs. those with preserved ejection fraction (HFpEF). Methods and results we included 381 patients included in the study, 209 had HFrEF and 172 had HFpEF. All the examinations were performed by cardiologists according to the instructions provided by the American Society of Echocardiography. In all patients LV volumes and diastolic function analysis were performed. A detailed examination of RV dimension and function were achieved by the measurement of right ventricular diameter at basal level, Pulmonary systolic pressure (PAPS), Tricuspid anular peak systolic excursion (TAPSE) and s wave by TDI analysis at RV free wall basal level. Finally longitudinal function was measured at lateral RV wall by post processing strain analysis. Overall, the median TAPSE was 19 (16–21) mm, the median of RVEDD was 40 (36–45) mm, the median PASP was 45 (35–50) mmHg and the median s’ wave was 11 (7–14). Patients with HFrEF demonstrated a larger RVEDD compared to HFpEF (44 ± 6 vs. 38 ± 5 P &amp;lt; 0.05) and more reduced TAPSE (16 ± 4 vs. 20 ± 3 P &amp;lt; 0.05). Whereas PAPS values were similar in both groups (47 ± 10 vs. 45 ± 10 NS). Conversely, s’ wave was much more reduced in HFpEF (9 ± 3 vs. 12 ± 4 P &amp;lt; 0.05) RV longitudinal strain was reduced in both group but HFpEF population demonstrated more impaired values (−18 ± 5 vs. −22 ± 8; P &amp;lt; 0.01). TAPSE/PAPS was significantly reduced in HFrEF (0.38 ± 8 vs. 0.43 ± 5 P &amp;lt; 0.01). Conversely s’/PAPS was more pronounced in HFpEF group (0.25 ± 4 vs. 0.29 ± 7 P &amp;lt; 0.05). At univariate analysis several parameters were related to outcome: TAPSE ≤ 14 mm, [HR: 1.70 (1.14–2.52); P = 0.009], PASP≥ 40 mmHg [HR: 1.51 (1.05–2.17); P = 0.02], RVEDD &amp;gt; 38 mm [HR: 1.88 (1.36–2.61); P &amp;lt; 0.001], s wave &amp;lt; 9 [HR: 1.88 (1.3–2.4), P &amp;lt; 0.001], inferior vena cava diameter &amp;gt; 21 mm [HR: 1.90 (1.31–2.75); P = 0.001]. Therefore TAPSE/PAPS was associated with adverse event in HFrEF but not in HFpEF (HR: 1.75 and HR: 1.02). Whereas, s/PAPS was associated with more increased risk in HFpEF (HR: 1.8 and HR: 1.3). Conclusions Right ventricular dysfunction and maladaptation are associated with poor outcome in either HFrEF and HFpEF. However tissue excursion and longitudinal strain are much more impaired in HFpEF, whereas RV dilatation and reduced longitudinal function are closely related to HFrEF. Different prognostic values and evaluation may be comprised during the evaluation of HFrEF and HFpEF.

Inferior vena cava diameter and collapsibility index as a marker of fluid status in regular hemodialysis patients

BackgroundPatients with renal failure suffer from fluid overload which is a risk factor for mortality and morbidity. Therefore, fluid status assessment in patients on regular hemodialysis is very important. Dry weight assessment by clinical parameters is not always reliable. We evaluate the role of inferior vena cava ultrasound in estimating fluid overload in regular hemodialysis patients.ResultsA total of 45 persons, 30 end-stage renal disease patients on regular hemodialysis in group A (18 men and 12 women) and 15 healthy persons in group B (10 men and 5 women), were included in the study. The patients in group A ages ranged from 29 to 70 years with a mean of 48.38 ± 12.70 years and in group B ages ranged from 25 to 55 years with a mean of 34.93 ± 8.26. By clinical methods, the mean dry weight was 68.37 kg (68.37 ± 10.42). After HD mean, IVCe decreased from 2.01 ± 0.29 to 1.79 ± 0.22 cm (P < 0.001) similarly, mean IVCi decreased from 0.99 ± 0.48 to 0.64 ± 0.39 cm (P < 0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (P < 0.001). The IVC-CI increased significantly after dialysis (P < 0.001). IVCD and its IVC-CI reflected alterations in fluid status (P < 0.001). Considering the clinical parameters of fluid status, following HD mean, heart rate increased from 81.80 ± 5.15 beats per minute to 89.87 ± 6.42, (P < 0.001), systolic blood pressure decreased from 130 ± 18.43 mmHg to 113.33 ± 15.27 (P < 0.001), and diastolic blood pressure decreased from 80.17 ± 10.12 mmHg to 71.50 ± 9.29 (P < 0.001).ConclusionIt was found a significant correlation between IVCD and IVC-CI with ultrafiltration of hemodialysis. Thus, IVC ultrasound can be used in dry weight assessment in ESRD patients on regular HD by measurement of IVCD and IVC-CI before and after hemodialysis.

Clinical value of point of care ultrasound on cardiac output and volume responsiveness in patients with septic shock

To assess the value of point of care ultrasound on cardiac output (CO) and volume responsiveness in patients with septic shock. Twenty-four mechanical ventilation patients with septic shock who needed pulse-indicated continuous cardiac output (PiCCO) monitoring in the department of critical care medicine of Zhengzhou University People's Hospital, Henan Provincial People's Hospital from November 25, 2020 to April 30, 2021 were selected as the subjects, the patient's basic information and laboratory test results were recorded. PiCCO was used as standard to monitor CO and stroke volume variability (SVV) at 0, 2, 6, 12, 24 and 48 hours. At the same time, point of care transthoracic echocardiography (TTE) was used to measure velocity time integral (VTI) and inferior vena cava diameter (dIVC), the CO, VTI variation rate (ΔVTI) and dIVC variation rate (ΔdIVC) were calculated. Then, using the value monitored by PiCCO as the standard, the consistency and correlation analysis were carried out between point of care ultrasound with PiCCO. Twenty-two out of 24 patients obtained satisfactory ultrasound Doppler images, the heart rate (HR), mean arterial pressure (MAP) and body temperature of the enrolled patients were consistent with the pathophysiological characteristics of septic shock. With the extension of treatment time, HR and CO both gradually decreased, and MAP gradually increased, reaching a peak or trough at 48 hours after admission. The difference were statistically significant compared with the time of admission [HR (bpm): 90.36±15.35 vs. 116.82±19.82, MAP (mmHg, 1 mmHg = 0.133 kPa): 87.82±11.06 vs. 58.82±9.85, CO (L/min): 4.80±0.56 vs. 6.78±1.31, all P < 0.05]. The CO obtained by PiCCO and point of care ultrasound had good agreement [5.36 (4.78, 6.33) L/min and 5.21 (4.88, 6.35) L/min, respectively], the average difference value at each time point was (-0.02±0.69) L/min, the 95% agreement limit range was -1.35-1.34, and there was a high degree of correlation (rs = 0.800, P < 0.001); The SVV by PiCCO and the ΔdIVC by point of care ultrasound were in good agreement [18.00% (14.00%, 24.00%) and 21.00% (14.00%, 25.75%), respectively], the average difference value at the time point was (-3.16±6.89)%, the 95% agreement limit range was -16.89-10.54, and there was a moderate correlation (rs = 0.702, P < 0.001); The SVV by PiCCO and the ΔVTI by point of care ultrasound were in good agreement [18.00% (14.00%, 24.00%) and 16.00% (11.25%, 20.75%), respectively], the average difference value at each time point was (13.03±14.75)%, and the 95% agreement limit range was 1.72-27.78, and there was a high correlation (rs = 0.918, P < 0.001). Point of care ultrasound can accurately assess CO and volume responsiveness of patients with septic shock, and the ΔVTI is better than the ΔdIVC in assessing volume responsiveness.

Correlation Between Liver Stiffness and Diastolic Function, Left Ventricular Hypertrophy, and Right Cardiac Function in Patients With Ejection Fraction Preserved Heart Failure.

Objective: Ejection fraction preserved heart failure (HFpEF) is a common clinical syndrome with a high morbidity, accounting for ~50% of all heart failure patients, and a mortality comparable to that of ejection fraction reduced heart failure (HFrEF). The relationship between liver stiffness (LS) and HFpEF remains unclear. The purpose of this study was to explore the correlation between LS and the severity of HFpEF.Methods: We performed a prospective observational study. After accepting liver transient elastography on admission, consecutive 150 hospitalized HFpEF patients were divided into three groups based on their liver elasticity value: first-third quartiles. Left ventricular diastolic function, left ventricular hypertrophy degree, right cardiac function and short-term prognosis (≤1 year) were compared among the three groups, and the correlation between liver elasticity and each indicator was analyzed.Results: The elasticity of the liver was abnormally high in more than two-thirds of cases. The proportion of NYHA class III-IV in the third quartile group was significantly higher than that in the first quartile group (96 vs. 70%, P = 0.013). Significant differences were discovered in the level of lgNT-proBNP between the three groups (2.63 ± 0.65 vs. 2.84 ± 0.44 vs. 3.05 ± 0.71, P = 0.027). In terms of diastolic function and left ventricular hypertrophy, the ventricular septal e′ (5.01 ± 2.69 vs. 6.48 ± 2.29, P = 0.025), lateral wall e′ (6.63 ± 3.50 vs. 8.62 ± 2.73, P = 0.013), mean E/e′ (20.06 ± 7.53 vs. 13.20 ± 6.05, P = 0.001), left atrial volume index (43.53 ± 10.94 vs. 35.78 ± 13.86, P = 0.008), tricuspid regurgitation (TR) peak flow rate (3.16 ± 0.44 vs. 2.75 ± 0.50, P < 0.001), left ventricular mass index (LVMI) in male (163.2 ± 47.6 vs. 131.3 ± 38.0, P = 0.015) and in female (147.4 ± 48.6 vs. 110.6 ± 24.3, P = 0.036) was significantly different between the third quartile and the first quartile. The proportion of patients with diastolic dysfunction in the third quartile was significantly higher than that in the first quartile (70 vs. 36%, P = 0.017). In terms of right cardiac function, right ventricular fractional area change (RVFAC) (30.3 ± 5.4 vs. 36.5 ± 6.8, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (7.7 ± 5.2 vs. 14.8 ± 5.9, P = 0.010), pulmonary systolic pressure (38.0 ± 10.5 vs. 32.4 ± 10.3, P = 0.005), TR peak flow rate (3.16 ± 0.44 vs. 2.75 ± 0.50, P < 0.001), and inferior vena cava diameter (2.53 ± 0.51 vs. 1.98 ± 0.41, P < 0.001) were significantly different between the third quartile and the first quartile. More than half of HFpEF patients were combined with right ventricular dysfunction (RVD). Compared to HFpEF without RVD, HFpEF with RVD had higher male sex (53.6 vs. 30.3%, P < 0.001), higher NYHA class (3.2 ± 0.6 vs. 2.8 ± 0.6, P = 0.010), higher proportion of atrial fibrillation (45.2 vs. 18.2%, P < 0.001), and higher liver elasticity value (7.95 ± 0.60 vs. 7.31 ± 0.84, P = 0.003). In terms of short-term prognosis, the incidence of adverse cardiovascular events was significantly higher in the third quartile than in the first quartile (P = 0.003) and the second quartile (P = 0.008). Multivariate Cox proportional hazard analysis showed that adverse cardiovascular events were independently associated with NYHA class, atrial fibrillation, lgNT-proBNP and liver elasticity value (HR = 1.208, 95% CI 1.115–1.352, P = 0.002).Conclusion: Increase of liver stiffness is common in HFpEF patients. Increased LS in HFpEF patients was significantly associated with worsen left diastolic function, left ventricular hypertrophy, and the right cardiac function. LS in HFpEF patients may be more than the result of right ventricular dysfunction. Male, atrial fibrillation, poorer NYHA class and increased liver elasticity value were significantly associated with HFpEF combined with RVD. Atrial fibrillation, poorer NYHA class, higher NT-proBNP, and increased liver elasticity value were independent predictors of poor short-term prognosis of HFpEF patients.

Inferior vena cava collapsibility index as a predictor of fluid responsiveness in sepsis-related acute circulatory failure

BackgroundAssessing fluid responsiveness is the key to successful resuscitation of critically-ill sepsis patients. The use of IVC variation is favored among the dynamic methods of fluid responsiveness assessment in the ICU because it is non-invasive and inexpensive; moreover, it does not demand a high level of training. The aim of this study is to determine the value of the IVC respiratory variability for predicting fluid responsiveness in spontaneously breathing sepsis patients with acute circulatory failure.ResultsIn this prospective observational study, fifty-eight spontaneously breathing sepsis patients admitted in the ICU were enrolled after the approval of the departmental Research Ethical Committee, and the informed written consent had been taken from the patients. Ultrasonographic and echocardiographic parameters were measured “IVC parameters and stroke volume (SV)” with calculation of the inferior vena cava collapsibility index (IVCCI) and cardiac output. These values were obtained before (baseline) and after volume expansion with a fluid bolus. The study showed that twenty-nine patients (50%) were considered to be responders, with an increase in CO by 10% or more after fluid challenge. There was a significant difference between responders and non-responders in baseline IVCCI (p value < 0.001). There were no significant differences between responders and non-responders in terms of demographic and baseline clinical characteristics. Also, there was statistically significantly larger maximum (IVC max) and minimum (IVC min) inferior vena cava diameters before volume expansion in non-responders than in responders with p value 0.037 and 0.001 respectively. The suggested cut off value regarding baseline IVCCI to predict response to fluid infusion is 0.32 with a high chance of response above this figure (a sensitivity of 72.41% and a specificity of 82.76%).ConclusionsInferior vena cava collapsibility index assessment can be a sensitive and a good predictor of fluid responsiveness, being based on a safe and a non-invasive technique compared to other methods such as central venous pressure (CVP) measurement and pulmonary artery catheter insertion.

C25. Cardiogenic shock in a 25-year-old male with tombstone ST-segment elevation pattern in emergency department, early hemodynamic assessment to guide the management: a case report of mixed cardiogenic shock phenotype

Abstract Background Cardiogenic shock (CS) is a lethal condition. There are several phenotypes, and classification based hemodynamic and/or clinical parameters for CS. We present CS with tombstone ST-segment elevation in emergency department (ED) with assessment of hemodynamic using bedside ultrasound to classify and guide the management. Case Description A 25-year-old-male complained sense of fatigue, fever, and myalgia for 2 days. The initial blood pressure and SpO2 were unrecordable, heart rate 112x/m, respiration rate 28x/m, temperature 36.8 °C. The patient was pale, anxious, with difficult jugular venous pressure assessment due to overweight appearance, diminished S1, and cold extremity. Electrocardiogram revealed tombstone ST-elevation in V2-V6, I, and aVL. After oxygenation management, initial dobutamine and norepinephrine, we performed bedside cardiac ultrasound revealed anterior left ventricular wall hypokinesis, mild pericardial effusion, ejection fraction 52%, mitral E/A ratio 2.7, E deceleration time 90.82ms, positive lung B-lines, inferior vena cava diameter 2.14cm with collapsibility &amp;lt;50%. Tricuspid annular plane systolic excursion 19mm. Estimated cardiac index 1.88L/m/cm2, and systemic vascular resistance (SVR) 775dynes.sec/cm5. This pattern suggests mixed CS phenotype. Vasopressor was up titrated with improved blood pressure, SpO2, and urinary output. CXR revealed cardiomegaly, troponin T &amp;gt; 10.000pg/ml. The patient was successfully stabilized in ED and transferred to ICCU. Discussion We classify our case as mixed CS. With hemodynamic assessment, we can determine the character of the shock with more objective parameters, guide the treatment, and avoiding over (increase oxygen demand, afterload, arrhythmia) and underused of vasopressor to bridging the treatment of causative factor.

C25. Cardiogenic shock in a 25-year-old male with tombstone ST-segment elevation pattern in emergency department, early hemodynamic assessment to guide the management: a case report of mixed cardiogenic shock phenotype

Abstract Background Cardiogenic shock (CS) is a lethal condition. There are several phenotypes, and classification based hemodynamic and/or clinical parameters for CS. We present CS with tombstone ST-segment elevation in emergency department (ED) with assessment of hemodynamic using bedside ultrasound to classify and guide the management. Case Description A 25-year-old-male complained sense of fatigue, fever, and myalgia for 2 days. The initial blood pressure and SpO2 were unrecordable, heart rate 112x/m, respiration rate 28x/m, temperature 36.8 °C. The patient was pale, anxious, with difficult jugular venous pressure assessment due to overweight appearance, diminished S1, and cold extremity. Electrocardiogram revealed tombstone ST-elevation in V2-V6, I, and aVL. After oxygenation management, initial dobutamine and norepinephrine, we performed bedside cardiac ultrasound revealed anterior left ventricular wall hypokinesis, mild pericardial effusion, ejection fraction 52%, mitral E/A ratio 2.7, E deceleration time 90.82ms, positive lung B-lines, inferior vena cava diameter 2.14cm with collapsibility &amp;lt;50%. Tricuspid annular plane systolic excursion 19mm. Estimated cardiac index 1.88L/m/cm2, and systemic vascular resistance (SVR) 775dynes.sec/cm5. This pattern suggests mixed CS phenotype. Vasopressor was up titrated with improved blood pressure, SpO2, and urinary output. CXR revealed cardiomegaly, troponin T &amp;gt; 10.000pg/ml. The patient was successfully stabilized in ED and transferred to ICCU. Discussion We classify our case as mixed CS. With hemodynamic assessment, we can determine the character of the shock with more objective parameters, guide the treatment, and avoiding over (increase oxygen demand, afterload, arrhythmia) and underused of vasopressor to bridging the treatment of causative factor.

Abstract 9126: Renal Venous Stasis Index Reflects Renal Congestion and Predicts Adverse Outcomes in Patients With Heart Failure

Background: It has been recently reported that the renal venous stasis index (RVSI) assessed by renal Doppler ultrasonography provides information to stratify pulmonary hypertension (PH) leading to right-sided heart failure. However, the clinical significance of RVSI on heart failure (HF) patients has not been fully examined. We aimed to clarify the associations of RVSI with parameters of cardiac function and right heart catheterization (RHC), as well as with prognosis, in patients with HF. Methods: We performed renal Doppler ultrasonography, echocardiography and RHC in hospitalized patients with HF (n = 388). The RVSI was calculated as follows: RVSI = (cardiac cycle time - venous flow time)/cardiac cycle time. These patients were divided into three groups based on RVSI: RVSI 0 group (RVSI = 0, n = 260, 67%), low RVSI group (0 &lt; RVSI ≤ 0.21, n = 65, 17%) and high RVSI group (RVSI &gt; 0.21, n = 63, 16%). We examined associations between RVSI and parameters of cardiac function and RHC, and followed up for cardiac events such as cardiac death and worsening HF. Results: There were significant correlations between RVSI and right atrial pressure (R = 0.253, P &lt;0.001), right atrial end-systolic area (R = 0.327, P &lt;0.001) and inferior vena cava diameter (R=0.327, P &lt;0.001), but not with cardiac index (R = -0.019, P = 0.769). During the follow-up periods (median 412 days), cardiac events occurred in 60 patients. In the Kaplan-Meier analysis, accumulated cardiac event rate increased with advancing RVSI (Figure, log-rank, P = 0.001). In the multivariable Cox proportional hazard analysis, cardiac event rate was independently associated with RVSI (hazard ratio, 1.874; 95% confidence interval, 1.023-3.435, P = 0.042). Conclusion: RVSI assessed by renal Doppler ultrasonography reflects right-sided overload and is associated with adverse prognosis in HF patients.

Hemodynamic Effects of Levosimendan in Outpatients With Advanced Heart Failure: An Echocardiographic Pilot Study.

Infusions of levosimendan delivered in ambulatory/outpatient settings have been shown to improve quality of life and reduce hospitalizations in patients with advanced heart failure (HF). The aim of this pilot study was to evaluate the effects of ambulatory infusion of levosimendan on echocardiographic markers of perfusion, congestion, and cardiovascular efficiency. Thirty patients with diagnosed advanced HF underwent ambulatorial infusion of levosimendan at a total dose of 6.25 mg as a part of a repetitive biweekly treatment strategy with the inotrope. Standardized transthoracic echocardiography and Doppler examinations, were performed 1 hour before and 48 hours after completion of ambulatory infusion. At 48 hours after ambulatory infusion of levosimendan, a significant increase in the stroke volume (37.47 ± 12.38 mL/beat vs. 45.47 ± 14.48 mL/beat; P < 0.05) and cardiac output (2.64 ± 0.66 L/min vs. 3.26 ± 0.57 L/min; P < 0.05) occurred. Significant postreductions versus prereductions were also recorded in left atrial pressure (27.37 ± 6.62 mm Hg vs. 22.82 ± 4.17 mm Hg; P < 0.01), mean pulmonary artery pressure (27.69 ± 4.64 mm Hg vs. 23.24 ± 5.32; P < 0.01), and inferior vena cava diameter (23.81 ± 7.63 mm vs. 18.53 ± 4.82 mm; P < 0.01). Significant improvements were noted in the resting cardiac power output (0.46 ± 0.15 watt vs. 0.53 ± 0.22 watt; P < 0.01) and the resting cardiac power index (0.24 ± 0.08 watt/m2 vs. 0.28 ± 0.11 watt/m2; P < 0.01). In outpatients with advanced HF, infusion of levosimendan was associated with hemodynamic responses that may contribute to the clinical benefit previously reported in such patients.

Inferior Vena Cava Collapsibility Index and Central Venous Pressure for Fluid Assessment in the Critically Ill Patient.

To determine the correlation of sonographic evaluation of inferior vena cava diameter and its collapsibility index with central venous pressure in both spontaneously breathing and mechanically ventilated patients in surgical ICU. Study Design: Cross-sectional study. Surgical ICU, Lahore General Hospital from November 2020 to May 2021. All patients above 18 years of age, who had central venous catheter placed, were included in the study. Patients with raised abdominal pressure, pregnancy, morbid obesity, heart diseases, and those unable to lie in supine position, were excluded. For inferior vena cava (IVC) measurement, IVC was visualised using curvilinear probe of ultrasound machine. Minimum and maximum diameters of inferior vena cava were calculated in every respiratory phase. IVC collapsibility index was expressed in percentage. Central venous pressure (CVP) was recorded soon after IVC measurement, using manometer. Total number of patients was 126. A significant correlation was seen between IVC measurements (inferior vena cava diameters and the collapsibility index) and CVP, (p<0.001), but the regression coefficients were less in patients who were mechanically ventilated (r=0.779 for IVC maximum diameter and -0.725 for collapsibility index) than the patients who were breathing spontaneously (r=0.850 for IVC maximum diameter and -0.899 for collapsibility index) Conclusion: Evaluation of IVC diameter and its collapsibility index is an easy and non-invasive method to evaluate intravascular volume status of critically ill patients. Its use is more helpful in patients who are spontaneously breathing than those who are mechanically ventilated. Key Words: Central venous pressure, Fluid status, Inferior vena cava diameter.