Changes in the Inferior Vena Cava Are More Sensitive Than Venous Pressure During Fluid Removal: A Proof-of-Concept Study
Por:
Posada-Martinez, Edith L., Cox, Zachary L., Cano-Nieto, Mariana M., Ibarra-Marquez, Nikein D., Moreno-Villagomez, Julieta, GUDIÑO-BRAVO P., Arias-Godinez, Jose A., Lopez-Gil, Salvador, Madero, Magdalena, Rao, Veena S., Mebazaa, Alexandre, Burkhoff, Daniel, Cowie, Martin R., Fudim, Marat, Damman, Kevin, Borlaug, Barry A., Testani, Jeffrey M., Ivey-Miranda, Juan B.
Publicada:
1 ene 2023
Categoría:
Cardiology and cardiovascular medicine
Resumen:
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. © 2022 The Authors
Filiaciones:
Posada-Martinez, Edith L.:
Laboratory of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Cox, Zachary L.:
Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennesee, United States
Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennesee, United States
Cano-Nieto, Mariana M.:
Laboratory of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Ibarra-Marquez, Nikein D.:
Laboratory of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Moreno-Villagomez, Julieta:
Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
Universidad Nacional Autónoma de México, Mexico City, Mexico
GUDIÑO-BRAVO P.:
Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Arias-Godinez, Jose A.:
Laboratory of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Lopez-Gil, Salvador:
Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Madero, Magdalena:
Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Rao, Veena S.:
Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
Mebazaa, Alexandre:
Université de Paris, Inserm 942 MASCOT, Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, APHP Nord, Paris, France
Burkhoff, Daniel:
Cardiovascular Research Foundation, New York, NY, United States
Cowie, Martin R.:
School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
Fudim, Marat:
Duke Clinical Research Institute, Durham, NC, United States
Division of Cardiology, Duke University Medical Center, Durham, NC, United States
Damman, Kevin:
University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
Borlaug, Barry A.:
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
Testani, Jeffrey M.:
Translational Catalyst, Guilford, CT, United States
Ivey-Miranda, Juan B.:
Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
Heart Failure and Heart Transplant Clinic, Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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