Inferior Vena Cava Collapsibility Index Assessed by 3D Echocardiography: A Novel Tool for the Assessment of Right Atrial Pressure in Heart Failure Patients

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Raikhelkar J, Kebed K, Narang A, Kruse E, Weatherford S, Imamura T., Wetterling F, Nguyen A, Sayer G, Lang R., Uriel N., Inferior Vena Cava Collapsibility Index Assessed by 3D Echocardiography: A Novel Tool for the Assessment of Right Atrial Pressure in Heart Failure Patients, Journal of the American Society of Echocardiography, 32, 6, 2019, 130 - 131Download Item:
Abstract:
Background: Inferior vena cava (IVC) size and respirophasic collapsibility by 2D
transthoracic echocardiography (2DE) have previously been shown to correlate weakly
with right atrial pressure (RAP) in patients with acute decompensated heart failure
(ADHF). Accurate 2DE dimensions are reliant on obtaining the correct imaging plane
and the assumption that the mostly elliptical IVC shape is circular, a limitation that 3D
echocardiography (3DE) can overcome. The aim of study was to determine the relationship
between invasively obtained RAP and IVC collapsibility as determined by 3DE in patients
with ADHF. Methods: Simultaneous measurements of RAP and 3DE recordings of the IVC
were performed in ADHF patients during clinically indicated right heart catheterizations.
Cross-sectional area and major and minor axis dimensions (Tomtec) were obtained at rest and end inspiration. An IVC collapsibility index was calculated for cross-sectional area
(3DE) using the following equation: ((Maximum area- Minimum area)/ Maximum area)
* 100. Results: 20 patients were enrolled. Mean age was 59 + 16 years, 52% were male,
and 60% of the patients were African American. 80% of the patients were NYHA class III
or IV, mean creatinine was 1.9 + 1.4 mg/dl, mean NT-proBNP was 6729 + 6142 pg/mL
and mean left ventricular ejection fraction was 31 +17%.Mean RA pressure was 12.7 +6.5
mm of Hg . RAP and IVC volume did not correlate well (r=0.17), regardless of whether
RAP was low or high. There was a strong correlation between RAP and IVC collapsibility
index (r= 0.63) ( Figure 1). Conclusion: 3DE derived IVC collapsibility index is a novel
noninvasive tool to assess RAP.RAP does not appear to correlate to IVC size or volume as
measured by 3DE in patients with ADHF. Further studies are needed to characterize this
parameter’s role in patient management.
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Author: Wetterling, Friedrich
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Journal of the American Society of EchocardiographyType of material:
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32;6;
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