Inferior vena cava dilation predicts global cardiac dysfunction in acute respiratory distress syndrome: A strain echocardiographic study

Abstract

Purpose Limited data exist on the utility of ultrasonographic evaluation of inferior vena cava (IVC) in acute respiratory distress syndrome (ARDS). We studied the value of IVC diameter in assessing cardio‐circulatory performance in ARDS using strain echocardiography. Materials and Methods Retrospective cross‐sectional analysis of Doppler echocardiograms of patients with moderate–severe ARDS was performed. Right ventricle (RV) parameters, IVC diameter, and left ventricle (LV) systolic and diastolic parameters were collected. RV free wall strain (RVFWS) and LV global longitudinal strain (LVGLS) were calculated. Results Fifty‐one patients were dichotomized into two groups: with IVC > 2.1 cm (dilated) and with IVC ≤ 2.1 cm (nondilated). The dilated IVC group presented worse hypoxemic profile, hypotension, and poor perfusion markers. No significant associations with positive end‐expiratory pressure or lung mechanics were observed. Dilated IVC was associated with impaired RV function, high central venous pressure, elevated pulmonary artery pressure, and LV systolic and diastolic dysfunctions. Strongest predictors of a dilated IVC were RVFWS, LVGLS, and tissue Doppler mitral annular early diastolic velocity. Dilated IVC predicted a global cardiac dysfunction defined by strain echocardiography (GCDS) with high sensitivity and specificity. Conclusions In ARDS, strain echocardiography analyses demonstrated that a dilated IVC is associated with GCDS and impaired hemodynamics independent of lung mechanics. A dilated IVC should be considered a marker of circulatory distress, signaling the potential necessity for improved hemodynamic optimization.

Assessment of Pulmonary Artery Diameters in Pediatric COVID-19 Patients

“…The morphology of IVC is frequently used to estimate right atrial pressure; however,the relationship between IVC morphology and RV outcomes has not been clarified completely 18 . Dilated IVC cases were found to be associated with RV dysfunction, high central venous pressure, and high pulmonary artery pressure 19 . High PVR can lead to IVC dilatation along with PH and RV deficiency.…”

“…High PVR can lead to IVC dilatation along with PH and RV deficiency. Some studies showed that IVC dilatation was one of the early indicators of disrupted hemodynamics in shock patients 19 . The mechanism of RV dilatation is multifactorial, and it involves thrombotic events, hypoxemic vasoconstriction, cytokines and direct viral damage.…”

Inferior Vena Cava Ultrasonography for Volume Status Evaluation: An Intriguing Promise Never Fulfilled

“…IVC dilatation had been suggested as a potential predictor of outcome in many different clinical contexts [ 64 , 65 , 66 ]. However, numerous physiological and pathophysiological conditions, as well as several interpretive pitfalls, have limited its wide applicability [ 24 ].…”