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

2012 ◽  
Author(s):  
Renato De Vecchis ◽  
Carmelina Ariano ◽  
Adelaide Fusco ◽  
Antonio Ciccarelli ◽  
Carmela Cioppa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Function ◽  
Observational Study ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Heart Failure Patients ◽  
Ultrasound Evaluation ◽  
Collapsibility Index

Increased Excretion of Aldosterone in Urine From Dogs With Right-Sided Congestive Heart Failure and From Dogs With Thoracic Inferior Vena Cava Constriction

1956 ◽  
Vol 187 (1) ◽  
pp. 45-50 ◽  
Author(s):  
James O. Davis ◽  
M. Jay Goodkind ◽  
Maurice M. Pechet ◽  
Wilmot C. Ball
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Inferior Vena Cava ◽  
Cardiac Failure ◽  
Inferior Vena ◽  
Vena Cava ◽  
Bilateral Adrenalectomy ◽  
Chromatographic Fractionation

Extracts of urine from 11 normal dogs, 9 dogs with cardiac failure and 10 dogs with thoracic inferior vena cava constriction and ascites were assayed for aldosterone-like activity. The activity in urine from dogs with heart failure and from dogs with thoracic caval constriction was equivalent to 52 and 167 µg/day of DCA, respectively, and renal Na excretion was uniformly low. No activity was detected in 4 days' urine from normal dogs but chromatographic fractionation and assay of a 26-day collection of normal dog urine showed Na-retaining and increased K-excreting activity in the aldosterone fraction only. Following bilateral adrenalectomy and discontinuation of DCA therapy in 2 dogs with caval constriction, all urinary aldosterone-like activity disappeared and a natriuresis occurred. Assays of chromatographic fractions of extracts of urine from dogs with heart failure and from dogs with caval constriction revealed activity only in the aldosterone fraction.

Ascites Formation Without Sodium Intake in Dogs With Thoracic Inferior Vena Cava Constriction and in Dogs With Right-Sided Congestive Heart Failure

1957 ◽  
Vol 188 (3) ◽  
pp. 578-582 ◽  
Author(s):  
Wilmot C. Ball ◽  
James O. Davis ◽  
M. Jay Goodkind
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Sodium Intake ◽  
Venous Pressure ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Edema Formation ◽  
Secondary Phenomenon

Dogs were subjected to constriction of the thoracic inferior vena cava or main pulmonary artery and were deprived of food for a period of 4 days thereafter. In association with a high venous pressure, 60% of the dogs formed ascites despite the absence of Na intake. Measurements of T-1824 dye space provided evidence that plasma volume was not increased. An increase in urinary excretion of aldosterone was associated with a markedly reduced urinary Na excretion. The data are interpreted as supporting the concept that elevated venous pressure initiates edema formation in congestive heart failure and that renal Na retention occurs as a secondary phenomenon.

scholarly journals Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study

2019 ◽  
Author(s):  
Marcell Szabó ◽  
Anna Bozó ◽  
Katalin Darvas ◽  
Alexandra Horváth ◽  
Zsolt Dániel Iványi
Keyword(s):  
Observational Study ◽  
Inferior Vena Cava ◽  
General Anesthesia ◽  
Roc Curve ◽  
Inferior Vena ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Collapsibility Index

Abstract Background: Intraoperative hypotension increases 30-day mortality and the risks of myocardial injury and acute renal failure. Patients with inadequate volume reserve before the induction of anesthesia are highly exposed. The identification of latent hypovolemia is therefore crucial. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) is able to detect volume responsiveness in circulatory shock. No current evidence is available regarding whether preoperative measurement of the IVCCI could identify patients at high risk for hypotension associated with general anesthesia. Methods: A total of 102 patients undergoing elective general surgery under general anesthesia with standardized propofol induction were recruited for this prospective observational study. The IVCCI was measured under spontaneous breathing. A collapsing (IVCCI≧50%) (CI+) and a noncollapsing (CI-) group were formed. Immediate postinduction changes in systolic and mean blood pressure were compared. The performance of the IVCCI as a diagnostic tool for predicting hypotension (systolic pressure <90 mmHg or a ≥30% drop from the baseline) was evaluated by ROC curve analysis. Results: A total of 83 patients were available for analysis, with 20 in the CI+ and 63 in the CI- group, we excluded 19 previously eligible patients due to inadequate visualization of the IVC (7 cases), lack of adherence to the protocol (8 cases), missing data (2 cases) or change in anesthesiologic management (2 cases). The mean decrease in systolic pressure in the CI+ group was 53.8±15.3 compared to 35.8±18.1 mmHg in CI- patients (P=0.0001). The relative mean arterial pressure change medians were 34.1% (IQR 23.2%-43.0%) and 24.2% (IQR 17.2%-30.2%), respectively (P=0.0029). The ROC curve analysis for IVCCI showed an AUC of 64.8% (95%CI 52.1-77.5%). The selected 50% level of the IVCCI had a sensitivity of only 45.5% (95%CI 28.1-63.7%), but the specificity was high at 90.0% (78.2-96.7%). The positive predictive value was 75.0% (95%CI 50.9-91.3%), and the negative predictive value was 71.4% (95%CI 58.7-82.1%). Conclusion: In spontaneously breathing preoperative noncardiac surgical patients, preoperatively detected IVCCI≧50% can predict postinduction hypotension with high specificity but low sensitivity. Despite moderate performance, IVCCI is an easy, noninvasive and attractive option to identify patients at risk and should be explored further.

Abstract 13532: Comparison of Inferior Vena Cava and Subclavian Vein Collapsibility Index by Ultrasound for Determination of Relative Intravascular Volume in Acute Decompensated Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yvonne E Kaptein ◽  
Pedro D Salinas ◽  
Payal Sharma ◽  
Ana Christina Perez Moreno ◽  
Nasir Sulemanjee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Inferior Vena Cava ◽  
Subclavian Vein ◽  
Inferior Vena ◽  
Acute Decompensated Heart Failure ◽  
Vena Cava ◽  
Decompensated Heart Failure ◽  
Right Atrial ◽  
Intravascular Volume ◽  
Collapsibility Index

Introduction: Accurate assessment of relative intravascular volume is needed to guide management of acute decompensated heart failure (ADHF). Current assessments include history and physical examination (specific but not sensitive), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (sensitive but not specific).Ultrasound (US) of inferior vena cava (IVC) collapsibility with respiration is commonly used to assess intravascular volume and right atrial pressure (RAP) but may be technically challenging. US of subclavian vein (SCV) collapsibility may provide an alternative assessment. Hypothesis: In ADHF, SCV collapsibility index (CI) may correlate with IVC CI and RAP. Methods: Prospective study of non-ventilated patients with ADHF who had NT-proBNP within 24 hours of paired IVC and SCV diameter measurements by US. Results: Forty-two patients (median age 66.5 years, 45% female, and 64% white) were enrolled, with 52 encounters. Cardiovascular comorbidities included hypertension (93%), chronic kidney disease (64%), coronary artery disease (55%), atrial fibrillation/flutter (55%), and valvular disease (55%). Of 38 patients with known heart failure, 63% had HFrEF, 16% HFmrEF, and 21% HFpEF.Correlation of paired IVC CI and SCV CI with relaxed breathing was R = 0.65 (N = 36). Correlation of paired IVC CI and SCV CI with forced inhalation was R = 0.47 (N = 36). Log 10 NT-proBNP was inversely correlated with IVC CI (R = -0.35; N = 51) and SCV CI (R = -0.33; N = 36). For patients with right heart catheterization within 24 hours of US, correlation of RAP to IVC CI was R = -0.53 (N = 9), and RAP to SCV CI was R = -0.65 (N = 9). Moderate or severe tricuspid regurgitation decreased CI independently of intravascular volume and RAP (figure). Conclusions: US measurements of SCV CI correlate well with paired IVC CI in non-ventilated ADHF. RAP by RHC correlated better with SCV CI than with IVC CI. SCV CI may be a reliable alternative to IVC CI in assessing relative intravascular volume.

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