Monitoring the response to treatment of acute heart failure patients by ultrasonographic inferior vena cava collapsibility index

• Published in: The American journal of emergency medicine Vol. 32; no. 5; pp. 403 - 407
• Main Authors: Yavaşi, Özcan, MD, Ünlüer, Erden Erol, MD, Kayayurt, Kamil, MD, Ekinci, Selim, MD, Sağlam, Caner, MD, Sürüm, Nebi, MD, Köseoğlu, Mehmet Hicri, MD, Yeşil, Murat, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2014; Elsevier Limited
• Subjects: Abdomen; Acute coronary syndromes; Aged; Aged, 80 and over; Blood; Cardiovascular disease; Case-Control Studies; Chronic illnesses; Chronic obstructive pulmonary disease; Echocardiography; Emergency; Emergency medical care; Emergency Service, Hospital; Female; Heart failure; Heart Failure - blood; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Heart Failure - therapy; Hospitalization; Hospitals; Humans; Male; Middle Aged; Monitoring, Physiologic - methods; Mortality; Natriuretic Peptide, Brain - blood; Patients; Peptide Fragments - blood; Prospective Studies; Studies; Turkey; Ultrasonic imaging; Vena Cava, Inferior - diagnostic imaging; Vena Cava, Inferior - physiopathology
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.12.046

Abstract Objective Our aim was to determine if N-terminal pro-brain natriuretic peptide (NT-proBNP) or sonographic measurements of inferior vena caval (IVC) diameters and collapsibility index (IVC-CI) have a role in the monitoring of acute heart failure (AHF) therapy. Methods Inferior vena caval diameters of 50 healthy people (control group) were measured to determine the normal values of the IVC parameters. We then prospectively enrolled patients who were admitted to the emergency department (ED) with a primary diagnosis of AHF. At presentation, IVC diameters were measured during expiration and inspiration, and blood was drawn for NT-proBNP. We repeated the measurement of the IVC parameters and collected a second blood sample 12 hours after the therapy was administered. The data were analyzed in SPSS 15.0 (IBM, Armonk, NY) using the Student t test and Mann-Whitney U test. Results A total of 97 subjects were enrolled: 47 in the patient group and 50 in the control group. The mean IVC during expiration was 2.10 ± 0.37 cm before and 1.57 ± 0.24 cm after the therapy ( P < .001). The mean IVC during inspiration was 1.63 ± 0.40 cm before and 0.90 ± 0.26 cm after the therapy ( P < .001). The mean IVC-CI rose from 22.80% ± 10.97% to 43.09% ± 13.63% ( P < .001). After the therapy, there was no difference between the IVC-CI of the patients and controls ( P = .246). There was no significant change in the mean NT-proBNP levels after the therapy. Conclusion Inferior vena caval collapsibility index may be helpful in monitoring AHF patients' responses to therapy in the ED.