Age-Related Decrease in Inferior Vena Cava Diameter Measured with Echocardiography

Abstract

The diameter of the inferior vena cava (IVC) measured with echocardiography is clinically used as a parameter to estimate right atrial pressure, which reflects dehydration or overhydration. Because elderly patients fall easily into dehydration, normal values for IVC diameters in elderly patients may be helpful for geriatric medicine. However, normal values of IVC diameter in relation to age have not been investigated. The purpose of this study was to elucidate age-related changes in IVC diameter using echocardiography. Enrolled in the study were 200 patients (67 ± 15 yrs: range 17-94 yrs) with cardiovascular risk factors but no overt cardiac diseases. IVC diameters throughout the respiratory cycle were measured as maximum and minimum IVC diameters (IVC max , IVC min ) using M-mode echocardiography. To assess IVC collapsibility, the respirophasic variation of IVC diameter was calculated as (IVC max -IVC min )/(IVC max ) × 100. Maximum IVC diameter was decreased with advancing age (r = -0.221, p = 0.002). The respirophasic variation of the IVC diameter was increased with advancing age (r = 0.244, p = 0.001). Stepwise multiple regression analysis showed that age was an independent determinant for both maximum IVC diameter (ß coefficient = -0.249, p < 0.001) and respirophasic variation of the IVC diameter (ß coefficient = 0.268, p < 0.001).Age-related decrease in maximum IVC diameter and increase in the respirophasic IVC collapsibility may indicate the decrease in right atrial pressure in some elderly patients. Therefore, elderly patients with decreased maximum IVC and increased respirophasic IVC collapsibility may need prevention for dehydration.

Impact of Body Size on Inferior Vena Cava Parameters for Estimating Right Atrial Pressure: A Need for Standardization?

“…Here, however, examination of the cutoff points in the higher and lower BSA groups revealed that optimal cutoff points for the identification of elevated RAP varied between the two groups. Similar to a prior study of patients without cardiac disease, 16 we also found a positive correlation between BSA and IVC size in patients with various forms of cardiac disease. These findings support the concept that the IVC size is affected by body size and the need for splitting cutoff points for predicting abnormal RAP in relation to BSA.…”

“…16 In the present study, the higher BSA group consisted of an older population with a larger proportion of men. Moreover, gender was associated with IVC diameter, whereas age was not.…”

Impact of individual characteristics on sonographic IVC diameter and the IVC diameter/aorta diameter index

“…In contrast to our findings, Masugata et al [12] found that age was accompanied by an increase in ΔDIVC in Japanese people in 2010. The authors suggest that low right atrial pressure and decreased IVC compliance in the elderly may have led to their results.…”

“…However, accurate data A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 6 on the effects of individual patient characteristics such as age, body mass index (BMI) and body surface area (BSA) on IVC parameters are lacking. Masugata et al (2010) reported an age-related reduction in maximum IVC diameter and an increase in the respiratory variation of IVC [12], but the participants in their study were older patients [15]. However, there has been little subsequent investigation of the utility of the index in evaluating volume status in either children or adults [16].…”

Inferior vena cava guided fluid resuscitation – Fact or fiction?

“…Masugata et al 32 investigated 200 patients from ages of 17e94 years old and found that increasing age was associated with reduced IVC diameter but increased IVC-CI. This may be due to physiological changes of the IVC wall.…”