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Inferior Vena Cava and Hemodynamic Congestion.

De Vecchis R, Baldi C - Res Cardiovasc Med (2015)

Bottom Line: Further, a substantially unsatisfactory concordance was also found for Stawicki's criteria compared to those of Pellicori (Cohen's kappa= 0.468; 95% CI 0.187 to 0.75).The abovementioned IVC ultrasonographic criteria for hemodynamic congestion appear clearly inconsistent.Alternatively, a sequential or simultaneous combination of clinical scores of congestion, IVC ultrasonographic indices, and circulating levels of natriuretic peptides could be warranted.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", Naples, Italy.

ABSTRACT

Background: Among the indices able to replace invasive central venous pressure (CVP) measurement for patients with acute decompensated heart failure (ADHF) the diameters of the inferior vena cava (IVC) and their respiratory fluctuations, so-called IVC collapsibility index (IVCCI), measured by echocardiography, have recently gained ground as a quite reliable proxy of CVP.

Objectives: The aims of our study were to compare three different ways of evaluating cardiac overload by using the IVC diameters and/or respiratory fluctuations and by calculating the inter-method agreement.

Patients and methods: Medical records of patients hospitalized for right or bi-ventricular acute decompensated heart failure from January to December 2013 were retrospectively evaluated. The predictive significance of the IVC expiratory diameter and IVC collapsibility index (IVCCI) was analyzed using three different methods, namely a) the criteria for the indirect estimate of right atrial pressure by Rudski et al. (J Am Soc Echocardiogr. 2010); b) the categorization into three IVCCI classes by Stawicki et al. (J Am Coll Surg. 2009); and c) the subdivision based on the value of the maximum IVC diameter by Pellicori et al. (JACC Cardiovasc Imaging. 2013).

Results: Among forty-seven enrolled patients, those classified as affected by persistent congestion were 22 (46.8%) using Rudski's criteria, or 16 (34%) using Stawicki's criteria, or 13 (27.6%) using Pellicori's criteria. The inter-rater agreement was rather poor by comparing Rudski's criteria with those of Stawicki (Cohen's kappa = 0.369; 95% CI 0.197 to 0.54), as well as by comparing Rudski's criteria with those of Pellicori (Cohen's kappa = 0.299; 95% CI 0.135 to 0.462). Further, a substantially unsatisfactory concordance was also found for Stawicki's criteria compared to those of Pellicori (Cohen's kappa= 0.468; 95% CI 0.187 to 0.75).

Conclusions: The abovementioned IVC ultrasonographic criteria for hemodynamic congestion appear clearly inconsistent. Alternatively, a sequential or simultaneous combination of clinical scores of congestion, IVC ultrasonographic indices, and circulating levels of natriuretic peptides could be warranted.

No MeSH data available.


Related in: MedlinePlus

(A) Representation of the IVC Collapsibility Index (IVCCI) and (B) IVCCI Measurement Using M-Mode UltrasonographyIVCCI consists of the difference between the end-expiratory (IVCd-exp) and end-inspiratory IVC diameter (IVCd-insp) divided by IVCd-exp. (B). Based on the measurements in this example, the IVCCI would be (18.3 - 3.80 mm) /18.3 mm, or 79.2 %.
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fig20913: (A) Representation of the IVC Collapsibility Index (IVCCI) and (B) IVCCI Measurement Using M-Mode UltrasonographyIVCCI consists of the difference between the end-expiratory (IVCd-exp) and end-inspiratory IVC diameter (IVCd-insp) divided by IVCd-exp. (B). Based on the measurements in this example, the IVCCI would be (18.3 - 3.80 mm) /18.3 mm, or 79.2 %.

Mentions: According to the customary approach used at our Centre, measurements of IVC diameters were obtained 1 to 2 cm below the level of the suprahepatic veins (Figure 1) using a two-dimensional echographic sector (Vivid 7 ultrasound machine, GE Healthcare Systems, Milwaukee, WI). The IVC diameter recording was made on M-mode approximately 3 cm from the right atrium with patients in a 45° recumbent position. Subcostal or subxiphoid windows were used based on available views, patient habitus, possible presence of external impediments, and preference of the sonologist. The measurements of the IVC expiratory diameter (IVCD exp) and IVCCI were noted, and their diagnostic significance was respectively analyzed.


Inferior Vena Cava and Hemodynamic Congestion.

De Vecchis R, Baldi C - Res Cardiovasc Med (2015)

(A) Representation of the IVC Collapsibility Index (IVCCI) and (B) IVCCI Measurement Using M-Mode UltrasonographyIVCCI consists of the difference between the end-expiratory (IVCd-exp) and end-inspiratory IVC diameter (IVCd-insp) divided by IVCd-exp. (B). Based on the measurements in this example, the IVCCI would be (18.3 - 3.80 mm) /18.3 mm, or 79.2 %.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4588705&req=5

fig20913: (A) Representation of the IVC Collapsibility Index (IVCCI) and (B) IVCCI Measurement Using M-Mode UltrasonographyIVCCI consists of the difference between the end-expiratory (IVCd-exp) and end-inspiratory IVC diameter (IVCd-insp) divided by IVCd-exp. (B). Based on the measurements in this example, the IVCCI would be (18.3 - 3.80 mm) /18.3 mm, or 79.2 %.
Mentions: According to the customary approach used at our Centre, measurements of IVC diameters were obtained 1 to 2 cm below the level of the suprahepatic veins (Figure 1) using a two-dimensional echographic sector (Vivid 7 ultrasound machine, GE Healthcare Systems, Milwaukee, WI). The IVC diameter recording was made on M-mode approximately 3 cm from the right atrium with patients in a 45° recumbent position. Subcostal or subxiphoid windows were used based on available views, patient habitus, possible presence of external impediments, and preference of the sonologist. The measurements of the IVC expiratory diameter (IVCD exp) and IVCCI were noted, and their diagnostic significance was respectively analyzed.

Bottom Line: Further, a substantially unsatisfactory concordance was also found for Stawicki's criteria compared to those of Pellicori (Cohen's kappa= 0.468; 95% CI 0.187 to 0.75).The abovementioned IVC ultrasonographic criteria for hemodynamic congestion appear clearly inconsistent.Alternatively, a sequential or simultaneous combination of clinical scores of congestion, IVC ultrasonographic indices, and circulating levels of natriuretic peptides could be warranted.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", Naples, Italy.

ABSTRACT

Background: Among the indices able to replace invasive central venous pressure (CVP) measurement for patients with acute decompensated heart failure (ADHF) the diameters of the inferior vena cava (IVC) and their respiratory fluctuations, so-called IVC collapsibility index (IVCCI), measured by echocardiography, have recently gained ground as a quite reliable proxy of CVP.

Objectives: The aims of our study were to compare three different ways of evaluating cardiac overload by using the IVC diameters and/or respiratory fluctuations and by calculating the inter-method agreement.

Patients and methods: Medical records of patients hospitalized for right or bi-ventricular acute decompensated heart failure from January to December 2013 were retrospectively evaluated. The predictive significance of the IVC expiratory diameter and IVC collapsibility index (IVCCI) was analyzed using three different methods, namely a) the criteria for the indirect estimate of right atrial pressure by Rudski et al. (J Am Soc Echocardiogr. 2010); b) the categorization into three IVCCI classes by Stawicki et al. (J Am Coll Surg. 2009); and c) the subdivision based on the value of the maximum IVC diameter by Pellicori et al. (JACC Cardiovasc Imaging. 2013).

Results: Among forty-seven enrolled patients, those classified as affected by persistent congestion were 22 (46.8%) using Rudski's criteria, or 16 (34%) using Stawicki's criteria, or 13 (27.6%) using Pellicori's criteria. The inter-rater agreement was rather poor by comparing Rudski's criteria with those of Stawicki (Cohen's kappa = 0.369; 95% CI 0.197 to 0.54), as well as by comparing Rudski's criteria with those of Pellicori (Cohen's kappa = 0.299; 95% CI 0.135 to 0.462). Further, a substantially unsatisfactory concordance was also found for Stawicki's criteria compared to those of Pellicori (Cohen's kappa= 0.468; 95% CI 0.187 to 0.75).

Conclusions: The abovementioned IVC ultrasonographic criteria for hemodynamic congestion appear clearly inconsistent. Alternatively, a sequential or simultaneous combination of clinical scores of congestion, IVC ultrasonographic indices, and circulating levels of natriuretic peptides could be warranted.

No MeSH data available.


Related in: MedlinePlus