TY - JOUR
T1 - Changes in the Inferior Vena Cava Are More Sensitive Than Venous Pressure During Fluid Removal
T2 - A Proof-of-Concept Study
AU - Posada-Martinez, EDITH L.
AU - COX, ZACHARY L.
AU - CANO-NIETO, MARIANA M.
AU - IBARRA-MARQUEZ, NIKEIN D.
AU - MORENO-VILLAGOMEZ, JULIETA
AU - GUDIÑO-BRAVO, PEDRO
AU - ARIAS-GODINEZ, JOSE A.
AU - LOPEZ-GIL, SALVADOR
AU - MADERO, MAGDALENA
AU - RAO, VEENA S.
AU - MEBAZAA, ALEXANDRE
AU - BURKHOFF, DANIEL
AU - COWIE, MARTIN R.
AU - FUDIM, MARAT
AU - DAMMAN, KEVIN
AU - BORLAUG, BARRY A.
AU - TESTANI, JEFFREY M.
AU - IVEY-MIRANDA, JUAN B.
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2023/4
Y1 - 2023/4
N2 - Background: Congestion is central to the pathophysiology of heart failure (HF); thus, tracking congestion is crucial for the management of patients with HF. In this study we aimed to compare changes in inferior vena cava diameter (IVCD) with venous pressure following manipulation of volume status during ultrafiltration in patients with cardiac dysfunction. Methods and Results: Patients with stable hemodialysis and with systolic or diastolic dysfunction were studied. Central venous pressure (CVP) and peripheral venous pressure (PVP) were measured before and after hemodialysis. IVCD and PVP were measured simultaneously just before dialysis, 3 times during dialysis and immediately after dialysis. Changes in IVCD and PVP were compared at each timepoint with ultrafiltration volumes. We analyzed 30 hemodialysis sessions from 20 patients. PVP was validated as a surrogate for CVP. Mean ultrafiltration volume was 2102 ± 667 mL. IVCD discriminated better ultrafiltration volumes ≤ 500 mL or ≤ 750 mL than PVP (AUC 0.80 vs 0.62, and 0.80 vs 0.56, respectively; both P< 0.01). IVCD appeared to track better ultrafiltration volume (P< 0.01) and hemoconcentration (P< 0.05) than PVP. Changes in IVCD were of greater magnitude than those of PVP (average change from predialysis: -58 ± 30% vs -28 ± 21%; P< 0.001). Conclusions: In patients undergoing ultrafiltration, changes in IVCD tracked changes in volume status better than venous pressure.
AB - Background: Congestion is central to the pathophysiology of heart failure (HF); thus, tracking congestion is crucial for the management of patients with HF. In this study we aimed to compare changes in inferior vena cava diameter (IVCD) with venous pressure following manipulation of volume status during ultrafiltration in patients with cardiac dysfunction. Methods and Results: Patients with stable hemodialysis and with systolic or diastolic dysfunction were studied. Central venous pressure (CVP) and peripheral venous pressure (PVP) were measured before and after hemodialysis. IVCD and PVP were measured simultaneously just before dialysis, 3 times during dialysis and immediately after dialysis. Changes in IVCD and PVP were compared at each timepoint with ultrafiltration volumes. We analyzed 30 hemodialysis sessions from 20 patients. PVP was validated as a surrogate for CVP. Mean ultrafiltration volume was 2102 ± 667 mL. IVCD discriminated better ultrafiltration volumes ≤ 500 mL or ≤ 750 mL than PVP (AUC 0.80 vs 0.62, and 0.80 vs 0.56, respectively; both P< 0.01). IVCD appeared to track better ultrafiltration volume (P< 0.01) and hemoconcentration (P< 0.05) than PVP. Changes in IVCD were of greater magnitude than those of PVP (average change from predialysis: -58 ± 30% vs -28 ± 21%; P< 0.001). Conclusions: In patients undergoing ultrafiltration, changes in IVCD tracked changes in volume status better than venous pressure.
KW - Heart failure
KW - congestion
KW - inferior vena cava
KW - venous pressure
UR - http://www.scopus.com/inward/record.url?scp=85141970374&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85141970374&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2022.09.012
DO - 10.1016/j.cardfail.2022.09.012
M3 - Article
C2 - 36243338
AN - SCOPUS:85141970374
SN - 1071-9164
VL - 29
SP - 463
EP - 472
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 4
ER -