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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

Inter-rater agreement between Rudski's and Pellicori classifications in our case-recordA rather poor agreement (Cohen’s Kappa = 0.299) is noticeable by comparing the criteria used for identifying hemodynamic congestion by means of the echographic exploration of the inferior vena cava (according to the classifications by Rudski or Pellicori, of whom the former uses the combined evaluation of IVC expiratory diameter and IVCCI, whereas the latter is based only on the assessment of IVC max). For instance, among the 18 patients having normal estimated CVP (0 - 5 mmHg) according to Rudski (first two columns on the left), only 6 (33.3%) were complying with the criterium (namely, IVC max = 16 [15 - 16] mm) for determining the presence of negligible or low risk of congestion, provided for by the classification made by Pellicori. Within the classification by Pellicori, note also that the reference values for each class of risk are expressed as median and interquartile range; Abbreviations: pts, patients; CVP, central venous pressure; IVCD exp, inferior vena cava expiratory diameter; IVCCI, inferior vena cava collapsibility index; IVC max, maximum inferior vena cava diameter; CI, confidence interval.
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fig20915: Inter-rater agreement between Rudski's and Pellicori classifications in our case-recordA rather poor agreement (Cohen’s Kappa = 0.299) is noticeable by comparing the criteria used for identifying hemodynamic congestion by means of the echographic exploration of the inferior vena cava (according to the classifications by Rudski or Pellicori, of whom the former uses the combined evaluation of IVC expiratory diameter and IVCCI, whereas the latter is based only on the assessment of IVC max). For instance, among the 18 patients having normal estimated CVP (0 - 5 mmHg) according to Rudski (first two columns on the left), only 6 (33.3%) were complying with the criterium (namely, IVC max = 16 [15 - 16] mm) for determining the presence of negligible or low risk of congestion, provided for by the classification made by Pellicori. Within the classification by Pellicori, note also that the reference values for each class of risk are expressed as median and interquartile range; Abbreviations: pts, patients; CVP, central venous pressure; IVCD exp, inferior vena cava expiratory diameter; IVCCI, inferior vena cava collapsibility index; IVC max, maximum inferior vena cava diameter; CI, confidence interval.

Mentions: As regards the estimation of positive cases when detected with the criteria of Stavicki or Pellicori, this was characterized by an unsatisfactory (“moderate”, according to the terminology used by Altman, Table 4) value of concordance (Cohen’s K: 0.468; CI 95%, 0.187 to 0.750). Likewise, the inter-rater agreement turned out rather poor (“fair”, Table 4) by comparing Rudski’s criteria with those of Stavicki (Cohen’s K: 0.369; 95% CI 0.197 to 0.540; Figure 2), as well as by comparing Rudski’s criteria with those of Pellicori (Cohen’s K: 0.299; CI 95%, 0.135 to 0.462; Figure 3). This argues for the fact that these criteria cannot be overlapped and that they are potentially contradictory and unfitted for mutual integration targeted to clinical purposes.


Inferior Vena Cava and Hemodynamic Congestion.

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

Inter-rater agreement between Rudski's and Pellicori classifications in our case-recordA rather poor agreement (Cohen’s Kappa = 0.299) is noticeable by comparing the criteria used for identifying hemodynamic congestion by means of the echographic exploration of the inferior vena cava (according to the classifications by Rudski or Pellicori, of whom the former uses the combined evaluation of IVC expiratory diameter and IVCCI, whereas the latter is based only on the assessment of IVC max). For instance, among the 18 patients having normal estimated CVP (0 - 5 mmHg) according to Rudski (first two columns on the left), only 6 (33.3%) were complying with the criterium (namely, IVC max = 16 [15 - 16] mm) for determining the presence of negligible or low risk of congestion, provided for by the classification made by Pellicori. Within the classification by Pellicori, note also that the reference values for each class of risk are expressed as median and interquartile range; Abbreviations: pts, patients; CVP, central venous pressure; IVCD exp, inferior vena cava expiratory diameter; IVCCI, inferior vena cava collapsibility index; IVC max, maximum inferior vena cava diameter; CI, confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig20915: Inter-rater agreement between Rudski's and Pellicori classifications in our case-recordA rather poor agreement (Cohen’s Kappa = 0.299) is noticeable by comparing the criteria used for identifying hemodynamic congestion by means of the echographic exploration of the inferior vena cava (according to the classifications by Rudski or Pellicori, of whom the former uses the combined evaluation of IVC expiratory diameter and IVCCI, whereas the latter is based only on the assessment of IVC max). For instance, among the 18 patients having normal estimated CVP (0 - 5 mmHg) according to Rudski (first two columns on the left), only 6 (33.3%) were complying with the criterium (namely, IVC max = 16 [15 - 16] mm) for determining the presence of negligible or low risk of congestion, provided for by the classification made by Pellicori. Within the classification by Pellicori, note also that the reference values for each class of risk are expressed as median and interquartile range; Abbreviations: pts, patients; CVP, central venous pressure; IVCD exp, inferior vena cava expiratory diameter; IVCCI, inferior vena cava collapsibility index; IVC max, maximum inferior vena cava diameter; CI, confidence interval.
Mentions: As regards the estimation of positive cases when detected with the criteria of Stavicki or Pellicori, this was characterized by an unsatisfactory (“moderate”, according to the terminology used by Altman, Table 4) value of concordance (Cohen’s K: 0.468; CI 95%, 0.187 to 0.750). Likewise, the inter-rater agreement turned out rather poor (“fair”, Table 4) by comparing Rudski’s criteria with those of Stavicki (Cohen’s K: 0.369; 95% CI 0.197 to 0.540; Figure 2), as well as by comparing Rudski’s criteria with those of Pellicori (Cohen’s K: 0.299; CI 95%, 0.135 to 0.462; Figure 3). This argues for the fact that these criteria cannot be overlapped and that they are potentially contradictory and unfitted for mutual integration targeted to clinical purposes.

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