Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ

Abstract

Journal of Patient-Centered Research and Reviews ( JPCRR) is a peerreviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations. Recommended CitationGaskamp M, Blubaugh M, McCarthy LH, Scheid DC. Can bedside ultrasound inferior vena cava measurements accurately diagnose congestive heart failure in the emergency department? A Clin-IQ. J Patient Cent Res Rev. 2016;3:230-4 Clinical QuestionIn adults, 18 years of age and older, who present to the emergency department (ED) with dyspnea, are inferior vena cava (IVC) measurements using bedside ultrasound as accurate as B-type natriuretic peptide (BNP) levels for identifying heart failure? Brief AnswerYes. Bedside ultrasound measurement of the IVC is a highly specific and rapid tool for diagnosing heart failure in the ED setting compared with BNP. BNP costs less than bedside ultrasound but is less specific and may take up to one hour or more at a clinical juncture when rapid detection of volume overload can rule in or rule out heart failure. In the studies reviewed, the specificity of the IVC measurement was as good as, or better than, BNP values. Ultrasound IVC measurements may be especially useful for cases in which BNP values fall into a nondiagnostic "gray zone" range. Based on current evidence, it seems reasonable to conclude that ultrasound IVC measurements, taken by properly trained ED clinicians, alone or in combination with BNP, would likely increase accuracy of diagnosing heart failure, allow earlier initiation of appropriate treatment and potentially reduce morbidity and mortality.Date of Literature Search: March/April 2016. Level of Evidence: B. Search TermsUltrasound, heart failure, inferior vena cava, pro-Btype natriuretic peptide, NR-PRoBNP, emergency department, diagnosis Inclusion CriteriaCurrent systematic reviews, meta-analyses, cohort studies, clinical research trials investigating the AbstractCongestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP also may have a "gray zone" in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of 87% and specificity of 74% at a cutoff of 400 pg/ml. Studies investigating bedside ultrasound inferior vena cava (IVC) measurements for identifying CHF report a specificity of 84% to 96% and sensitivity values ranging from 37% to 93%, depending on the study. efficacy of ultrasound measurements of the IVC for diagnosing heart failure in the ED. Exclusion CriteriaChildren less than 1...

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“…A summary paper on the accuracy of IVC measurements in detecting congestive heart failure calculated 84-96% specificity when using IVC CI cut-off of <15% to identify congestive heart failure. [ 19 ] Our patient's IVC CI cut-off as 7.5% met the former mentioned criteria, supporting the diagnosis of decompensated heart failure.…”

SONO case series: a 63-year-old male with shortness of breath

“…From the subxiphoid view, rotating the probe marker to the patient’s head and moving rightward allows for a sagittal view of the inferior vena cava (IVC) (figure 6). The IVC can give an assessment of volume status, and particularly in patients where there is concern for poor cardiac output, it can be used for assessment of volume overload 2 3. The diameter of the IVC is measured within 1 to 2 cm of the right atrium (RA), and the patient is asked to perform an inspiratory manoeuvre, such as sniffing, and the amount of collapse from exhalation to inspiration noted.…”

Monitoring patients with acute dyspnoea with a serial focused ultrasound of the heart and the lungs (MODUS): a protocol for a multicentre, randomised, open-label, pragmatic and controlled trial

“…11 Ultrasound of the IVC is also used as a diagnostic tool for the identification of congestive heart failure in patients presenting with dyspnoea. 12 Focused lung ultrasound (FLUS) can be used to diagnose interstitial syndrome (lung diseases affecting the lung interstitium, eg, lung oedema), lung consolidation, pneumothorax or pleural effusion. [13][14][15] In some studies, FLUS [16][17][18][19][20] and ultrasound of the IVC [21][22][23] have been used to monitor and guide therapy in patients with acute dyspnoea, but the studies were clinically heterogenic.…”