Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Abstract

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study ABSTRACTObjective: In chronic heart failure (CHF), collapsibility index of the inferior vena cava (IVCCI) is used for noninvasive ultrasonographic appraisal of central venous pressure, but it also may be related both to estimated glomerular filtration rate (eGFR) and renal outcome. Methods: On the basis of retrospective observational cohort study, we analyzed 49 patients with right or biventricular CHF in III NYHA class, who had undergone intravenous intensive treatment with furosemide. Aggravated renal dysfunction (ARD) was defined by serum creatinine (Cr) increase of ≥0.3 mg/dL from baseline. IVCCI was categorized in three layers (IVCCI ≤15%, IVCCI 16-40% and IVCCI >40%). The predictors of ARD were searched for as well as any relation between basal IVCCI and both eGFR at admission and occurrence of ARD. Results: Overall, 15 cases and 34 controls were compared. Multivariate predictors of ARD were a lower basal eGFR (HR: 0.82 CI: 0.72-0.94 p=0.0045) and intravenous furosemide daily mean dose >80 mg (HR: 48.62 CI: 1.62-3841.5 p=0.0430). A very significant positive correlation was found between IVCCI at admission ≤ 15% and basal eGFR (r=0.96 p<0.0001), while a negative correlation with eGFR was detected in the IVCCI highest (>40%) range (r=-0.696 p=0.0013). Furthermore, the category with basal IVCCI >40% showed a higher rate of ARD compared to that with basal IVCCI 16-40% (p<0.05). Conclusion:On the basis of the demonstrated u-shaped relationship between IVCCI and eGFR both the stratum with the highest (>40%) and the one with the lowest (≤15%) basal IVCCI may be associated with increased risk of ARD. (Anadolu Kardiyol Derg 2012; 12: 391-400) Key words: Heart failure, ultrasound monitoring, inferior vena cava, diuretics, acute kidney injury, regression analysis

Inferior vena cava parameters predict re‐admission in ischaemic heart failure

“…clinical relevance of our results so that it may be considered a pilot study. Thus, we need larger clinical trials confirming our results and the previous studies providing same results with similar sample size [29,42,43]. Moreover, the cohort of HF patients was recruited in a single hospital, so that the overall heart failure community might be not truly represented.…”

Inferior vena cava collapsibility index, renal dysfunction, and adverse outcomes in patients with broad spectrum cardiovascular disease

“…Besides, reduced glomerular filtration rate by experimentally induced hypervolemia in dogs was independent of cardiac systolic function and renal blood flow . In recent human studies, right atrial pressure was demonstrated to be a hemodynamic parameter that correlated with baseline renal function and adverse cardiovascular events . In patients with HF, renal vein congestion was described as a contributor to worsening renal function as well as reduced renal blood flow .…”

“…21 In recent human studies, right atrial pressure was demonstrated to be a hemodynamic parameter that correlated with baseline renal function and adverse cardiovascular events. 12,22 In patients with HF, renal vein congestion was described as a contributor to worsening renal function as well as reduced renal blood flow. [9][10][11]23 In a non-HF population, an epidemiologic association was also demonstrated between an increased central venous pressure and reduced glomerular filtration rate.…”

“…), who was blinded to the study results, determined the IVCCI by reviewing every set of two‐dimensional echocardiography images that had been stored in Digital Imaging and Communications in Medicine (DICOM) file format. The diameter of the IVC was measured within 2 cm from the right atrium; the minimum diameter was obtained during full forced inspiration, whereas the maximum diameter was obtained during expiration . The IVCCI was determined by the ratio of the minimum and maximum diameters of the IVC according to the following formula:…”

“…The diameter of the IVC was measured within 2 cm from the right atrium; the minimum diameter was obtained during full forced inspiration, whereas the maximum diameter was obtained during expiration. 4,12 The IVCCI was determined by the ratio of the minimum and maximum diameters of the IVC according to the following formula 8 :…”