Echocardiographic Evaluation of Left Ventricular Filling Pressure in Patients With Heart Failure With Preserved Ejection Fraction: Usefulness of Inferior Vena Cava Measurements and 2016 EACVI/ASE Recommendations

Berthelot, Emmanuelle; Jourdain, Patrick; Bailly, Minh Tam; Bouchachi, Amir; Gellen, Barnabas; Rouquette, Alexandra; Damy, Thibaud; Hervé, Philippe; Chemla, Denis; Assayag, Patrick

doi:10.1016/j.cardfail.2020.01.018

Cited by 14 publications

(14 citation statements)

References 34 publications

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“…SCV CI and IVC CI may also reflect RAP in patients with rate-controlled atrial fibrillation/flutter. 27 The limitations of our study are that this is a pilot study with a small but adequately powered sample size, and echocardiograms assessing the severity of TR were not obtained on the same day as SCV and IVC ultrasound.…”

Section: Discussionmentioning

confidence: 97%

Comparison of subclavian vein to inferior vena cava collapsibility by ultrasound in acute heart failure: A pilot study

Kaptein

2021

Clinical Cardiology

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Background: Management of acute decompensated heart failure (ADHF) requires accurate assessment of relative intravascular volume, which may be technically challenging. Inferior vena cava (IVC) collapsibility with respiration reflects intravascular volume and right atrial pressure (RAP). Subclavian vein (SCV) collapsibility may provide an alternative. Hypothesis:The purpose of this study was to examine the relationship between SCV collapsibility index (CI) and IVC CI in ADHF.Methods: This was a prospective study of non-ventilated patients with ADHF who had paired IVC and SCV ultrasound assessments. As SCV CI is highly positiondependent, measurements were performed supine at 30-45°.Results: Thirty-three patients were included with 36 encounters. The sample size was adequately powered for receiver-operator characteristic (ROC) analysis. SCV CI correlated with IVC CI during relaxed breathing (R = .65, n = 36, p < .001) and forced inhalation (R = .47, n = 36, p = .0036). SCV CI < 22% and >33% corresponded to IVC CI < 20% and >50% suggesting hypervolemia (sensitivity/specificity: 72%) and hypovolemia (sensitivity/specificity: 78%), respectively. Moderate to severe tricuspid regurgitation (TR) compared to less than moderate TR was associated with lower SCV CI (medians: 12.4% vs. 25.3%, p = .022) and IVC CI (medians: 9.6% vs. 35.6%, p = .0012). SCV CI and IVC CI were not significantly different among chronic kidney disease stages. Conclusion:In non-ventilated ADHF, SCV CI at 30-45°correlates with paired IVC CI, and may provide an alternative to IVC CI for assessment of relative intravascular volume, which may facilitate clinical management. Moderate to severe TR decreases SCV CI and IVC CI and may result in overestimation of relative intravascular volume.

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Section: Discussionmentioning

confidence: 97%

Comparison of subclavian vein to inferior vena cava collapsibility by ultrasound in acute heart failure: A pilot study

Kaptein

2021

Clinical Cardiology

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“…More recently, 3 papers evaluated the diagnostic performance of the 2016 ASE/EACVI algorithm in patients with LVEF ≥50%. 10 , 11 , 17 Ran et al reported high sensitivity and specificity (84% and 80%, respectively) in patients with PH of different etiologies. 17 This was in a relatively small study (N=63) and other cardiac causes for elevated filling pressure were not excluded, which may have overestimated diagnostic performance.…”

Section: Discussionmentioning

confidence: 99%

“…In accordance with our study, the 2 remaining studies reported low diagnostic accuracy of the echo‐algorithm in patients suspected for HFpEF. 10 , 11 Furthermore, a recently published systematic review underlined the limited evidence available for the individual echo‐parameters in patients with HFpEF and found only a modest correlation between E/e′ and LV filling pressures in patients with HFpEF ( r =0.62). 9 …”

Section: Discussionmentioning

confidence: 99%

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Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction

Bovenkamp

Enait

Man

et al. 2021

JAHA

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Background Echocardiography is considered the cornerstone of the diagnostic workup of heart failure with preserved ejection fraction. Thus far, validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) echo‐algorithm for evaluation of diastolic (dys)function in a patient suspected of heart failure with preserved ejection fraction has been limited. Methods and Results The diagnostic performance of the 2016 ASE/EACVI algorithm was assessed in 204 patients evaluated for unexplained dyspnea or pulmonary hypertension with echocardiogram and right heart catheterization. Invasively measured pulmonary capillary wedge pressure (PCWP) was used as the gold standard. In addition, the diagnostic performance of H 2 FPEF score and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) were evaluated. There was a poor correlation between indexed left atrial volume, E/e′ (septal and average) or early mitral inflow (E), and PCWP ( r =0.25–0.30, P values all <0.01). No correlation was found in our cohort between e′ (septal or lateral) or tricuspid valve regurgitation and PCWP. The correlation between diastolic function grades of the ASE/EACVI algorithm and PCWP was poor ( r =0.17, P <0.05). The ASE/EACVI algorithm had a sensitivity and specificity of 35% and 87%, respectively; an accuracy of 67% and an area under the curve of 0.56. Moreover, in 30% of cases the algorithm was not applicable or indeterminate. H 2 FPEF score had a modest correlation with PCWP ( r =0.44, P <0.0001), and accuracy was 73%; NT‐proBNP correlated weakly with PCWP ( r =0.24, P <0.001), and accuracy was 57%. Conclusions The 2016 ASE/EACVI algorithm for the assessment of diastolic function has a limited diagnostic accuracy in patients evaluated for unexplained dyspnea and/or pulmonary hypertension, and especially sensitivity to detect diastolic dysfunction was low.

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“…Moreover, an extensive literature indicates that the echocardiographic evaluation of IVC offers diagnostic and prognostic cues per se, regardless of which value is assigned to eRAP IVC . Demonstration of a dilated and/or non-collapsible IVC may be sufficient to identify patients with HF and increased LV filling pressures (29) and has been associated with HF hospitalization and mortality (19,30,31). In addition, a larger IVC size at discharge was related to a higher risk of readmission after a first hospitalization for HF (32,33).…”

Section: Discussionmentioning

confidence: 99%

Multiparametric vs. Inferior Vena Cava–Based Estimation of Right Atrial Pressure

Toma

Giovinazzo

Masoero

et al. 2021

Front. Cardiovasc. Med.

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Background: Right atrial pressure (RAP) can be estimated by echocardiography from inferior vena cava diameter and collapsibility (eRAPIVC), tricuspid E/e′ ratio (eRAPE/e′), or hepatic vein flow (eRAPHV). The mean of these estimates (eRAPmean) might be more accurate than single assessments.Methods and Results: eRAPIVC, eRAPE/e′, eRAPHV (categorized in 5, 10, 15, or 20 mmHg), eRAPmean (continuous values) and invasive RAP (iRAP) were obtained in 43 consecutive patients undergoing right heart catheterization [median age 69 (58–75) years, 49% males]. There was a positive correlation between eRAPmean and iRAP (Spearman test r = 0.66, P < 0.001), with Bland–Altman test showing the best agreement for values <10 mmHg. There was also a trend for decreased concordance between eRAPIVC, eRAPE/e′, eRAPHV, and iRAP across the 5- to 20-mmHg categories, and iRAP was significantly different from eRAPE/e′ and eRAPHV for the 20-mmHg category (Wilcoxon signed-rank test P = 0.02 and P < 0.001, respectively). The areas under the curve in predicting iRAP were nonsignificantly better for eRAPmean than for eRAPIVC at both 5-mmHg [0.64, 95% confidence interval (CI) 0.49–0.80 vs. 0.70, 95% CI 0.53–0.87; Wald test P = 0.41] and 10-mmHg (0.76, 95% CI 0.60–0.92 vs. 0.81, 95% CI 0.67–0.96; P = 0.43) thresholds.Conclusions: Our data suggest that multiparametric eRAPmean does not provide advantage over eRAPIVC, despite being more complex and time-consuming.

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Echocardiographic Evaluation of Left Ventricular Filling Pressure in Patients With Heart Failure With Preserved Ejection Fraction: Usefulness of Inferior Vena Cava Measurements and 2016 EACVI/ASE Recommendations

Cited by 14 publications

References 34 publications

Comparison of subclavian vein to inferior vena cava collapsibility by ultrasound in acute heart failure: A pilot study

Comparison of subclavian vein to inferior vena cava collapsibility by ultrasound in acute heart failure: A pilot study

Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction

Multiparametric vs. Inferior Vena Cava–Based Estimation of Right Atrial Pressure

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