Abstract
Introduction
This study aims to evaluate the accuracy of bedside assessment of inferior vena cava
(IVC) and right internal jugular (RIJ) vein in predicting right atrial (RA) pressure
in heart failure patients.
Methods
We prospectively studied 124 heart failure patients who were referred to our catheterization
laboratory for right heart catheterizations to assess hemodynamics and to guide heart
failure management. Just prior to the procedure, a handheld ultrasound examination
was performed in each patient. The volume status was assessed by estimating RA pressure
using end-expiratory IVC dimension, IVC respiratory collapsibility, and RIJ respiratory
collapsibility. Patients were divided into 2 groups based on invasive RA pressure
value. Multiple logistic regression models were used to identify factors associated
with RA ≥10 mm Hg; a 3-point simple score was then created. The performance of this
score was assessed using the receiver operating characteristics curve.
Results
In this study 124 heart failure patients were included; median age was 59 years (interquartile
range 48-65), and 40% were female. RIJ respiratory collapsibility <50%, end-expiratory
IVC dimension ≥21 mm, and respiratory collapsibility <50% were significantly associated
with elevated RA pressure, and were used to build the score. The area under the receiver
operating characteristics curve (AUC) for the 3-point score was 0.84 (0.77-0.92),
and it performed better than 2-point score using IVC characteristics alone (AUC 0.84
[0.77-0.92] vs 0.75 [0.67-0.83]; P = .003). Of 124 patients, 90 patients (72.5%) had concordant RA pressure and pulmonary
capillary wedge pressure.
Conclusion
Concomitant ultrasound assessment of RIJ and IVC correlated better with RA pressure
than IVC alone. A simple 3-point score can provide a useful and easily accessible
tool to estimate volume status, and further guide management of heart failure patients.
Keywords
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Article Info
Publication History
Published online: December 30, 2021
Footnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors have access to the data and have made substantial contributions to the study design, data analysis and interpretation, and drafting the article, and all approved the final version.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
