Year : 2015 | Volume
: 4 | Issue : 3 | Page : 3-
Inferior vena cava and hemodynamic congestion
Renato De Vecchis1, Cesare Baldi2
1 Cardiology Unit, Presidio Sanitario Intermedio “Elena d’Aosta”, Naples, Italy
2 Heart Department, Interventional Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy
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 fluctuationsj 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 methodsj 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 patientsj those classified as affected by persistent congestion were 22 (46.8%) using Rudski’s criteria1 or 16 (34%) using Stawicki’s criteriaj 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 indicesj and circulating levels of natriuretic peptides could be warranted.
Renato De Vecchis
Cardiology Unit, Presidio Sanitario Intermedio “Elena d’Aosta”, Naples
|How to cite this article:|
De Vecchis R, Baldi C. Inferior vena cava and hemodynamic congestion.Res Cardiovasc Med 2015;4:3-3
|How to cite this URL:|
De Vecchis R, Baldi C. Inferior vena cava and hemodynamic congestion. Res Cardiovasc Med [serial online] 2015 [cited 2021 Sep 26 ];4:3-3
Available from: https://www.rcvmonline.com/article.asp?issn=2251-9572;year=2015;volume=4;issue=3;spage=3;epage=3;aulast=De;type=0