Three-Dimensional Inferior Vena Cava for Assessing Central Venous Pressure in Patients with Cardiogenic Shock

Non-invasive assessment of central venous pressure in heart failure: a systematic prospective comparison of echocardiography and Swan-Ganz catheter

“…Similar to our results, Huguet et al reported discrepancy for 2DE measurements of CVP, showing systematic underestimation, mostly for 2DE foreshortening artifacts [ 9 ]. Given the clinical implications of such measurements in guiding medical strategy in HF decompensation or cardiogenic shock, the discrepancies between 2DE estimations and actual CVP values are concerning [ 13 ].…”

“…3DE is widely available, simple, can be performed at the bedside and is already part of daily practice, making it a better choice for determining comprehensive IVC geometry [ 11 ]. Respiratory position influences IVC geometry [ 9 ], which is why our standardized study measurements were reported as breathing-corrected values; in addition, we did not require an additional “sniff” test. Moreover, in contrast to other studies, we investigated an unselected, all-comers HF population, making our findings potentially applicable to a broad group of patients.…”

“…Therefore, there is a need for a non-invasive alternative but none is currently available. Most clinicians take the approach of estimating CVP using two-dimensional echocardiography (2DE) to estimate inferior vena cava (IVC) size in the subcostal view [ 9 ]. However, interobserver variability is high and agreement with invasive measurement is poor [ 10 ].…”

“…However, interobserver variability is high and agreement with invasive measurement is poor [ 10 ]. This is due to the often elliptical and irregular shape of the IVC and the variegating angle in which the ultrasound window depicts the vessel, making it impossible to capture the real dimension of the IVC with any two-dimensional approach [ 9 ]. It has been suggested that three-dimensional echocardiography (3DE) has the potential to capture CVP, but time consuming vessel area registration and complex calculations of a collapsibility and eccentricity index are needed to achieve reproducible and accurate measurements, making this approach impractical in daily clinical routine [ 9 ].…”

“…This is due to the often elliptical and irregular shape of the IVC and the variegating angle in which the ultrasound window depicts the vessel, making it impossible to capture the real dimension of the IVC with any two-dimensional approach [ 9 ]. It has been suggested that three-dimensional echocardiography (3DE) has the potential to capture CVP, but time consuming vessel area registration and complex calculations of a collapsibility and eccentricity index are needed to achieve reproducible and accurate measurements, making this approach impractical in daily clinical routine [ 9 ]. Cross-section measurements of IVC short and long axis were found to have potential for estimating CVP, but this was mainly limited to the ability to detect CVP of < 10 versus ≥ 10 mmHg [ 11 ].…”