Echocardiographic Assessment of Central Venous Pressure using Inferior Vena Cava Indices: An Estimate Guide for Right Atrial Pressure
DOI:
https://doi.org/10.47672/ajhmn.2496Abstract
Purpose: To assess the correlation between inferior vena cava echocardiographic indices and central venous pressure, right atrial pressure and thus to practice, assessment of inferior vena cava, as a guide for the status of right side of the heart.
Materials and Methods: In this descriptive cross-sectional study, a total of (60) patients (males and females) with their age ranging between (18–80) years were admitted to the respiratory care unit. Echocardiographic assessment of inferior vena cava hemodynamics (IVC expiratory, IVC inspiratory diameters and IVC collapsibility index) were carried out. In addition to the standard echocardiography examination, right heart function measurements (Tricuspid Annular Plane Systolic Excursion and right atrial area), in spontaneously and mechanically ventilated, patients were done.
Findings: Both IVCe and IVCi diameters showed strong negative correlation with collapsibility index, (r= -0.920 for IVCe and r= -0.964 for IVCi) (P<0.001). There was a positive correlation between TAPSE and IVC-CI (r=0.857, P<0.001). Moreover, RA area was negatively correlated with collapsibility index (r = -0.892, P <0.001). IVC-CI in mechanically ventilated patients (40.11± 1.782) compared to spontaneous breathing (48.91± 1.811) (P <0.001)
Implications to Theory, Practice and Policy: There was a linear relationship of IVC collapsibility index with TAPSE but an inverse relation with RA area. Evaluation of IVC diameter and its collapsibility index was an easy and non-invasive method to estimate CVP and RAP and so evaluate right heart performance of critically ill patients. Its use is more helpful in patients who are spontaneously breathing than those who are mechanically ventilated. The study tried to find an estimate predictor of right atrial pressure.
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References
- Mascherbauer J, et al. Presence of ‘isolated’ tricuspid regurgitation should prompt the suspicion of heart failure with preserved ejection fraction. PLoS ONE. 2017;12(2).
- Vanderpool RR, et al. RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension. Heart. 2015;101(1):37–43.
- Zaidi A, Knight DS, Augustine DX, et al. Echocardiographic assessment of the right heart in adults: a practical guideline from the British Society of Echocardiography. Echo Res Pract. 2020;7(1): G19-G41.
- Obokata M, Kane GC, Sorimachi H, Reddy YNV, Olson TP, Egbe AC, Melenovsky V, Borlaug BA.Noninvasive evaluation of pulmonary artery pressure during exercise: the importance of right atrial hypertension. European Respiratory Journal 2020. 55 1901617.
- Austin C, et al. Echocardiographic assessment of estimated right atrial pressure and size predicts mortality in pulmonary arterial hypertension. Chest. 2015;147(1):198–208.
- Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2016; 37: 67–119.
- Marcelli E, Cercenelli L, Bortolani B, et al. A Novel Non-Invasive Device for the Assessment of Central Venous Pressure in Hospital, Office and Home. Med Devices (Auckl). 2021; 14:141-154.
- Tawfeeq HA, Al-Omary H, Haji GF. The impact of left ventricular thickness in hypertensive heart disease on right ventricular function: an Echocardiographic Strain Study. IOSR Journal of Pharmacy and Biological Sciences. 2018; 13:9-12.
- Ciozda W, Kedan I, Kehl DW, Zimmer R, Khandwalla R, Kimchi A. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound. 2016;14(1):33.
- D’Ascenzi, F., Cameli, M., Padeletti, M. et al. Characterization of right atrial function and dimension in top-level athletes: a speckle tracking study. Int J Cardiovasc Imaging 29, 87–94 (2013).
- Jue J, Chung W, Schiller NB. Does inferior vena cava size predict right atrial pressures in patients receiving mechanical ventilation? J Am Soc Echocardiogr. 1992; 5:613–9.
- Ciozda, W., Kedan, I., Kehl, D.W. et al. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound 14, 33 (2015).
- Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med. 2010; 55:290–295.
- Abdelwahab HW, El-Wahab RA. Correlation of bedside ultrasonographic measurement of ivc diameter and caval index with CVP in spontaneously breathing and mechanically ventilated patients. J Emerg Med Critical Care 2017; 3(1):2.
- Wiryana M, Sinardja IK, Aryabiantara IW, Senapathi TG, Widnyana IMG, Aribawa IGNM, et al. Central venous pressure correlates with inferio vena cava collapsibility index in patients treated in intensive care unit. Bali J Anesthesiol 2017; 1(1):7-9.
- Shalaby M, Roshdy H, Elmahdy W, El Mezayen A. Correlation between central venous pressure and the diameter of inferior vena cava by using ultrasonography for the assessment of the fluid status in intensive care unit patients. The Egyptian Journal of Hospital Medicine 2018; 72(10): 5375-84.
- Abd Al-Majeed MM, Mohammed NH, Haji GF. Role of Two-Dimensional Speckle Tracking Strain versus Conventional Echocardiography in the Assessments of Left Ventricular Systolic Function in Middle-aged Hypertensive Patients. Journal of the Faculty of Medicine. 2019;61(1).
- Stawicki SP, Hoff WS, Cipolla J. Use of the esophageal echo‑Doppler to guide intensive care unit resuscitations: a retrospective study. Indian J Crit Care Med 2007; 11:54–60.
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Copyright (c) 2024 Dr. Wisam Jasim Mohammed, Dr. Khalid Muhsin Hassan, Dr. Mushtaq Talib Yassin
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