Elevated Central Venous Pressure Estimated by Echocardiography Associates with Increased Neurohumoral Activity and Renal Insufficiency in Acute Decompensated Heart Failure

Abstract Background Accurate volume status assessment is crucial for the treatment of acute decompensated heart failure (ADHF). Volume status assessment by physical exam is inaccurate, necessitating invasive measurement with right heart catheterization (RHC), which carries safety, pragmatic (scheduling, holding anticoagulants, etc) and financial burdens. Therefore, a reliable, non-invasive, cost-effective alternative is desired. Previously, we developed an ultrasound (US) based technique to measure internal jugular vein (IJV) compliance during RHC which was used for single time point central venous pressure (CVP) predictions. We now aim to apply this technique to track acute changes in CVP during diuresis for ADHF in patients with an in-dwelling pulmonary artery catheter. Purpose The objective of our study was to devise a rapid, portable and reliable alternative to RHC to track acute volume changes during treatment of ADHF. Methods We used an observational, prospective study design and recruited 15 patients from the CCU between 7/19–12/19 being treated for ADHF (systolic or diastolic) with IV diuretics +/−inotropic agents who underwent PA catheter insertion for continuous CVP monitoring. 13 of 15 patients received milrinone infusions. US images of the IJV were obtained at end expiration and during the strain phase of Valsalva at multiple 2–3 hr intervals. Change in IJV cross sectional area (ImageJ) was used as a measure of IJV compliance. Patients unable to perform the Valsalva maneuver and on mechanical circulatory support were excluded. Results Calculated % change in CSA of IJV was plotted against CVP. An inverse relationship was observed between CVP and % change in CSA of IJV. The data was fit with an inverse exponential regression shown in Figure 1 (R2=0.36, root mean square error = 3.19). Fivefold cross validation showed a stable model for predicting CVP based CSA (R2=0.34, root mean square error = 3.26) Conclusion Serial portable US assessment of IJV compliance can act a surrogate measure of CVP and,therefore, can provide reliable information on acute hemodynamic changes in ADHF. Funding Acknowledgement Type of funding source: None

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Bedside Ultrasound to Assess Acute Central Venous Pressure Change During Treatment of Decompensated Heart Failure

SSRN Electronic Journal ◽

10.2139/ssrn.3986170 ◽

2021 ◽

Author(s):

Shumail Fatima ◽

William Lambert ◽

Mehdi Nouraie ◽

John Pacella

Keyword(s):

Heart Failure ◽

Central Venous Pressure ◽

Venous Pressure ◽

Pressure Change ◽

Decompensated Heart Failure ◽

Bedside Ultrasound ◽

Central Venous

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Faculty Opinions recommendation of Peripheral Venous Pressure Measurements in Patients With Acute Decompensated Heart Failure (PVP-HF).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727798869.793541126 ◽

2018 ◽

Author(s):

Nancy Sweitzer

Keyword(s):

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Venous Pressure ◽

Decompensated Heart Failure ◽

Pressure Measurements ◽

Peripheral Venous Pressure

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Excess fluid volume: clinical validation in patients with decompensated heart failure

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692011000300013 ◽

2011 ◽

Vol 19 (3) ◽

pp. 540-547 ◽

Cited By ~ 9

Author(s):

Quenia Camille Soares Martins ◽

Graziella Badin Aliti ◽

Joelza Chisté Linhares ◽

Eneida Rejane Rabelo

Keyword(s):

Heart Failure ◽

Jugular Vein ◽

Venous Pressure ◽

Decompensated Heart Failure ◽

Cross Sectional Study ◽

Fluid Volume ◽

University Hospital ◽

Central Venous ◽

Cross Sectional ◽

Nursing Diagnosis

This cross-sectional study aimed to clinically validate the defining characteristics of the Nursing Diagnosis Excess Fluid Volume in patients with decompensated heart failure. The validation model used follows the model of Fehring. The subjects were 32 patients at a university hospital in Rio Grande do Sul. The average age was 60.5 ± 14.3 years old. The defining characteristics with higher reliability index (R): R ≥ 0.80 were: dyspnea, orthopnea, edema, positive hepatojugular reflex, paroxysmal nocturnal dyspnea, pulmonary congestion and elevated central venous pressure, and minor or secondary, R> 0.50 to 0.79: weight gain, hepatomegaly, jugular vein distention, crackles, oliguria, decreased hematocrit and hemoglobin. This study indicates that the defining characteristics with R> 0.50 and 1 were validated for the diagnosis Excess Fluid Volume.

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Ultrasound Guided Noninvasive Measurement of Central Venous Pressure

Encyclopedia of Healthcare Information Systems ◽

10.4018/978-1-59904-889-5.ch167 ◽

2008 ◽

pp. 1331-1337

Author(s):

Vikram Aggarwal ◽

Yoonju Cho ◽

Aniruddha Chatterjee ◽

Dickson Cheung

Keyword(s):

Heart Failure ◽

Central Venous Pressure ◽

Venous Pressure ◽

Vena Cava ◽

Heart Association ◽

Systemic Circulation ◽

The Body ◽

Physiological Parameter ◽

Central Venous ◽

Mean Pressure

Central venous pressure (CVP) is a measure of the mean pressure within the thoracic vena cava, which is the largest vein in the body and responsible for returning blood from the systemic circulation to the heart. CVP is a major determinant of the filling pressure and cardiac preload, and like any fluid pump, the heart depends on an adequate preload to function effectively. Low venous return translates into a lower preload and a drop in overall cardiac output, a relationship described by the Frank-Starling Mechanism. CVP is an important physiological parameter, the correct measure of which is a clinically relevant diagnostic tool for heart failure patients. In addition to other vitals such as heart rate and mean arterial pressure, accurate measures of central venous pressure through simple diagnostic instrumentation would provide physicians with a clear picture of cardiac functionality, and allow for more targeted treatment. Recent literature has also shown that measuring CVP can be an important hemodynamic indicator for the early identification and treatment of more widespread conditions, such as sepsis (Rivers, Nguyen, Havstad, & Ressler, 2001). With over five million patients (American Heart Association, http://www.americanheart.org/presenter. jhtml) in the U.S. presenting with heart failure-like symptoms annually, a current challenge for physicians is to obtain a quick and accurate measure of a patient’s central venous pressure in a manner that poses minimum discomfort.

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