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Sampath-Kumar R, Ben-Yehuda O. Inferior vena cava diameter and risk of acute decompensated heart failure rehospitalisations. Open Heart 2023; 10:e002331. [PMID: 37696618 PMCID: PMC10496688 DOI: 10.1136/openhrt-2023-002331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVES Inferior vena cava (IVC) diameter may be a surrogate for volume status in acute decompensated heart failure (ADHF). The utility of IVC diameter measurement is under studied. The aim of this study was to assess the relationship between IVC diameter, clinical variables and ADHF rehospitalisations. METHODS Retrospective chart review of 200 patients admitted for ADHF from 2018 to 2019 with transthoracic echocardiogram during index hospitalisation. Charts were assessed for ADHF rehospitalisation within 1 year. RESULTS The median age was 64, 30.5% were female, and average left ventricular ejection fraction was 41%±20%. IVC diameter correlated to pulmonary arterial (PA) pressure (R=0.347, p<0.001) and body surface area (BSA) (R=0.424 p<0.001). IVC diameter corrected for BSA correlated to PA pressure (R=0.287, p<0.001) and log N-terminal B-type natriuretic peptide (NT-proBNP) (R=0.247, p≤0.01). Patients rehospitalised within 1 year had significantly greater mean IVC diameter compared with those not rehospitalised (p<0.001) while there was no difference in mean net weight lost during index hospitalisation or mean log NT-proBNP. Patients with IVC diameter greater than 2.07 cm had significantly increased ADHF rehospitalisation (85.6% vs 49.3%, log rank p<0.001) with HR 2.44 (95% CI 1.85 to 3.23, p<0.001). In multivariable Cox regression only IVC diameter (p<0.001), presence of tricuspid regurgitation (p=0.02) and NYHA class III/IV (p<0.001) independently predicted ADHF rehospitalisation within 1 year. CONCLUSIONS IVC diameter is predictive of rehospitalisation in patients with ADHF and may identify patients in need of greater monitoring and diuresis.
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Affiliation(s)
- Revathy Sampath-Kumar
- Cardiology, University of California San Diego Health Sciences, La Jolla, California, USA
| | - Ori Ben-Yehuda
- Cardiology, University of California San Diego Health Sciences, La Jolla, California, USA
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High Inferior Vena Cava Diameter with High Left Ventricular End Systolic Diameter as a Risk Factor for Major Adverse Cardiovascular Events, Cardiovascular and Overall Mortality among Chronic Hemodialysis Patients. J Clin Med 2022; 11:jcm11185485. [PMID: 36143131 PMCID: PMC9503705 DOI: 10.3390/jcm11185485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Little is known about the association of inferior vena cava diameter (IVCD) and left ventricular end-systolic diameter (LVESD) with mortality in patients undergoing hemodialysis (HD). Methods: The single medical center observational cohort study enrolled 241 adult chronic HD patients from 1 October 2018 to 31 December 2018. Echocardiography results of IVCD and LVESD prior to dialysis were retrieved and patients were divided into high IVCD and low IVCD groups. Patients who received HD via a tunneled cuffed catheter were excluded. Study outcomes included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Subgroup analyses of HD patients with high and low LVESD were also performed. Results: The incidence of all-cause mortality, cardiovascular mortality, and MACE were higher in chronic HD patients with high IVCD (p < 0.01). High IVCD patients had significantly greater all-cause mortality, cardiovascular mortality, and MACE (log-rank test; p < 0.05). High IVCD patients are also associated with an increased risk of all-cause mortality and MACE relative to low IVCD patients (aHRs, 2.88 and 3.42; 95% CIs, 1.06−7.86 and 1.73−6.77, respectively; all p < 0.05). In the subgroup analysis of patients with high or low LVESD, the high IVCD remained a significant risk factor for all-cause mortality and MACE, and the HR is especially high in the high LVESD group. Conclusions: Dilated IVCD is a risk factor for all-cause mortality and MACE in chronic HD patients. In addition, these patients with high LVESD also have a significantly higher HR of all-cause mortality and MACE.
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Arvig MD, Laursen CB, Jacobsen N, Gæde PH, Lassen AT. Monitoring patients with acute dyspnea with serial point-of-care ultrasound of the inferior vena cava (IVC) and the lungs (LUS): a systematic review. J Ultrasound 2022; 25:547-561. [PMID: 35040102 PMCID: PMC9402857 DOI: 10.1007/s40477-021-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The primary aim was to investigate if treatment guided by serial ultrasound of the inferior vena cava-collapsibility index (IVC-CI) and B-lines on lung ultrasound (LUS) could reduce mortality, readmissions, and length of stay (LOS) in acutely dyspneic patients admitted to a hospital, compared to standard monitoring. The secondary aim was to determine how the changes of B-lines and IVC-CI are correlated to vitals and symptoms. METHODS A systematic search was conducted on PubMed, Embase, Cochrane, Google Scholar, Web of Science, Scopus, OpenGrey, ProQuest, and databases for ongoing trials. The risk of bias was assessed according to study design. RESULTS Of the 8258 studies identified, 50 were selected for full-text screening, and 24 studies were chosen for data extraction (19 pre-post-, two non-randomized controlled-, two randomized controlled-, and one retrospective cohort study), covering 2040 patients. Most studies were single-center and had small study populations with only heart failure patients. The risk of bias was high. No studies evaluated how the difference between two ultrasound measurements correlated with the primary outcomes. Seven studies reported that a decline in either B-lines or IVC size, or an increased IVC-CI reduced mortality, readmissions, and LOS when correlated to a single ultrasound measurement. All studies showed changes in the IVC-CI and B-lines, but these were not related to vitals or symptoms. CONCLUSION B-lines and IVC-CI are dynamic variables that change over time and with treatment. A single ultrasound measurement can influence prognostic outcomes, but it remains uncertain if repeated scans can have the same impact.
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Affiliation(s)
- Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Niels Jacobsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Regional Center for Technical Simulation, TechSim, Odense, Denmark
| | - Peter Haulund Gæde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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Spiliotaki E, Saranteas T, Moschovaki N, Panagouli K, Pistioli E, Kitsinelis V, Briasoulis P, Papadimos T. Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: A critical analysis review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:733-744. [PMID: 35302241 DOI: 10.1002/jcu.23194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
Rapid evaluation of intravascular volume status is vital; either excessive or limited fluid administration may result in adverse patient outcomes. In this narrative review, critical analysis of pertinent diagnostic accuracy studies is developed to delineate the role of inferior vena cava ultrasound measurements in the assessment of both intravascular volume status and fluid responsiveness in the emergency department and intensive care unit. In addition, limitations, and technical considerations of inferior vena cava ultrasound measurements as well as directions for future research are thoroughly discussed.
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Affiliation(s)
- Eleni Spiliotaki
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodosios Saranteas
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
- Department of Anesthesia, Division of critical care, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nefeli Moschovaki
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Panagouli
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathia Pistioli
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Kitsinelis
- Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Briasoulis
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Papadimos
- Department of Anesthesia, Division of critical care, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Roy S, Kothari N, Goyal S, Sharma A, Kumar R, Kaloria N, Bhatia P. Preoperative assessment of inferior vena cava collapsibility index by ultrasound is not a reliable predictor of post-spinal anesthesia hypotension. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022:S0104-0014(22)00051-3. [PMID: 35430190 PMCID: PMC10362455 DOI: 10.1016/j.bjane.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Post-spinal anesthesia hypotension is of common occurrence, and it hampers tissue perfusion. Several preoperative factors determine patient susceptibility to hypotension. This study aimed to assess the effectiveness of the Inferior Vena Cava Collapsibility Index (IVCCI) for predicting intraoperative hypotension. METHODS One hundred twenty-nine adult patients who were scheduled for elective surgical procedures after administration of spinal (intrathecal) anesthesia were included in the study. Ultrasound evaluation of the Inferior Vena Cava (IVC) was done in the preoperative area, and the patients were shifted to the Operating Room (OR) for spinal anesthesia. An independent observer recorded the change in blood pressure after spinal anesthesia inside the OR. RESULTS Twenty-five patients developed hypotension (19.37%). Baseline systolic blood pressure and mean blood pressures were statistically higher in those patients who developed hypotension (p = 0.001). The logistic regression analysis for IVCCI and the incidence of hypotension showed r2 of 0.025. Receiver Operating Characteristic (ROC) curve analysis demonstrated the Area Under the Curve (AUC) of 0.467 (95% Confidence Interval, 0.338 to 0.597; p = 0.615). CONCLUSIONS Preoperative evaluation of IVCCI is not a good predictor for the occurrence of hypotension after spinal anesthesia.
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Affiliation(s)
- Shayak Roy
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Nikhil Kothari
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Shilpa Goyal
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Ankur Sharma
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India.
| | - Rakesh Kumar
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Narender Kaloria
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
| | - Pradeep Bhatia
- All India Institute of Medical Sciences (AIIMS), Department of Anaesthesiology & Critical Care, Jodhpur, India
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Leahova-Cerchez X, Berthelot E, Genet B, Hanon O, Jourdain P. Estimation of the plasma volume status of elderly patients with acute decompensated heart failure using bedside clinical, biological, and ultrasound parameters. Clin Cardiol 2022; 45:379-385. [PMID: 35233791 DOI: 10.1002/clc.23791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Assessment of intravascular volume status to ensure optimization before hospital discharge could significantly reduce readmissions. It is difficult to evaluate congestion on clinical signs during an episode of acute heart failure (ADHF) in elderly patients. HYPOTHESIS There is an association between various volume overload parameters in patients older than 75 years. METHODS We performed a single-center prospective longitudinal study of patients older than 75 years hospitalized for acute heart failure. We analyzed the association between congestion assessment based on clinical signs, inferior vena cava (IVC) diameter measured by ultrasound, biological evaluation with N terminal pro brain natriuretic peptide (NT-proBNP), and estimated plasma volume (EPV) during decongestive therapy. We also monitored changes in renal function. RESULTS Fifty consecutive ADHF patients (85.2 ± 5.9 years, 68% female) were included in the study. At admission, a dilated, noncompliant IVC was found in all patients. The strongest correlations between different parameters of volume overload estimation were found between IVC and jugular vein distention (r = .8; p < .001), then IVC and oedema (r = .6; p < .001), IVC and crackles (r = .3; p < .036), then IVC and NT-proBNP (r = .3; p = .02). There was no correlation between EPV and signs of congestion. Patients who had no congestive signs on clinical or IVC examination at Day 2, more often presented with acute renal failure. CONCLUSION In ADHF patients older than 75 years, clinical and IVC evaluation of intravascular congestion correlate well. The concomitant assessment of clinical signs and IVC may prevent depletion-related renal failure.
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Affiliation(s)
- Xenia Leahova-Cerchez
- Hôpital Broca, Service de Gérontologie, Assistance Publique-Hôpitaux de Paris and EA 4468, Université de Paris, Paris, France
| | - Emmanuelle Berthelot
- Department of Cardiology, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Bastien Genet
- Department of Biostatistics, Université Paris Sud, Le Kremlin-Bicêtre, France.,Department of Statistics and Methodology in Biomedical Research, Paris-Saclay University, Gif-sur-Yvette, France
| | - Olivier Hanon
- Hôpital Broca, Service de Gérontologie, Assistance Publique-Hôpitaux de Paris and EA 4468, Université de Paris, Paris, France
| | - Patrick Jourdain
- Department of Cardiology, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Vecchi AL, Muccioli S, Marazzato J, Mancinelli A, Iacovoni A, De Ponti R. Prognostic Role of Subclinical Congestion in Heart Failure Outpatients: Focus on Right Ventricular Dysfunction. J Clin Med 2021; 10:jcm10225423. [PMID: 34830705 PMCID: PMC8625381 DOI: 10.3390/jcm10225423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND subclinical pulmonary and peripheral congestion is an emerging concept in heart failure, correlated with a worse prognosis. Very few studies have evaluated its prognostic impact in an outpatient setting and its relationship with right-ventricular dysfunction. The study aims to investigate subclinical congestion in chronic heart failure outpatients, exploring the close relationship between the right heart-pulmonary unit and peripheral congestion. MATERIALS AND METHODS in this observational study, 104 chronic HF outpatients were enrolled. The degree of congestion and signs of elevated filling pressures of the right ventricle were evaluated by physical examination and a transthoracic ultrasound to define multiparametric right ventricular dysfunction, estimate the right atrial pressure and the pulmonary artery systolic pressure. Outcome data were obtained by scheduled visits and phone calls. RESULTS ultrasound signs of congestion were found in 26% of patients and, among this cohort, half of them presented as subclinical, affecting their prognosis, revealing a linear correlation between right ventricular/arterial coupling, the right-chambers size and ultrasound congestion. Right ventricular dysfunction, TAPSE/PAPS ratio, clinical and ultrasound signs of congestion have been confirmed to be useful predictors of outcome. CONCLUSIONS subclinical congestion is widespread in the heart failure outpatient population, significantly affecting prognosis, especially when right ventricular dysfunction also occurs, suggesting a strict correlation between the heart-pulmonary unit and volume overload.
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Affiliation(s)
- Andrea Lorenzo Vecchi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (R.D.P.)
- Correspondence:
| | - Silvia Muccioli
- Department of Cardiology, Mauriziano Umberto I Hospital, 10128 Torino, Italy;
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (R.D.P.)
| | - Antonella Mancinelli
- Department of Cardiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (A.M.); (A.I.)
| | - Attilio Iacovoni
- Department of Cardiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (A.M.); (A.I.)
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (R.D.P.)
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Can Inferior Vena Cava Diameter and Collapsibility Index Be a Predictor in Detecting Preoperative Intravascular Volume Change in Pediatric Patients? JOURNAL OF CARDIOVASCULAR EMERGENCIES 2021. [DOI: 10.2478/jce-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Inferior vena cava (IVC) ultrasound measurement is a reliable indicator used in the assessment of intravascular volume status. The aim of this study was to evaluate intravascular volume changes in pediatric patients by measuring the IVC diameter and collapsibility index (CI) in children whose oral feeding was restricted preoperatively. Material and Methods: From May 2018 to October 2018, a total of 55 pediatric patients who were scheduled for surgery were included in this prospective, observational, cohort study. Fasting and satiety IVC diameters and CIs of patients were determined by ultrasonographic evaluation twice: in the preoperative preliminary evaluation, when the patients were satiated, and before surgery, during a fasting period of 6–8 hours. Ultra-sonographic data were recorded and compared between fasting and satiety periods. Results: In the grey scale (B-mode), mean IVC diameter was significantly higher when the patients were satiated, compared to the measurements made just before surgery during the fasting period. In the M-mode, the mean IVC diameter was significantly higher only during the inspiratory phase when the patients were satiated, while during the expiratory phase it was detected to be statistically similar. Mean CI was significantly higher in the immediate preoperative period, compared to the assessment made when satiated. Conclusion: Preoperative ultrasound IVC diameter and CI measurement can be a practical and useful method for evaluating preoperative intravascular volume in children.
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Role of Pocket Ultrasound in Assessing Intravascular Volume to Guide Management in Heart Failure Patients with Renal Impairment. Cardiol Ther 2021; 10:491-500. [PMID: 34173941 PMCID: PMC8555013 DOI: 10.1007/s40119-021-00229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Inpatient management of patients with heart failure (HF) and renal impairment is challenging. We sought to evaluate the role of pocket ultrasound (US)-guided management of this patient population. Methods We prospectively included patients with acute HF exacerbation and renal impairment admitted to the HF service in our University hospital from January 2017 to August 2018. We compared the outcomes of patients who received US-guided management with those who received standard of care management. The main study outcome was the change in estimated glomerular filtration rate (eGFR). Multivariable logistic analysis was used to adjust for basic demographics and risk factors. Results A total of 211 patients with renal impairment presenting with acute HF exacerbation (mean age 66.8 ± 14.6 years, 41% females, 62% white) were enrolled in the study, of whom 69 (32.7%) received US-guided management and 151 (68%) received standard of care management. The change in the eGFR was significantly lower in US-guided group than in the group receiving standard of care (1.1 ± 4.3% vs. − 11.15 ± 2.9%; p = 0.04). No significant difference was observed between the patient groups in the length of stay (6.45 ± 0.38 vs. 6.44 ± 0.56; days; p = 0.98) and in the 30-day HF readmission rate (hazard ratio 1.27, 95% confidence interval 0.28–5.6; p = 0.75). Conclusion Ultrasound-guided management of patients admitted with acute HF exacerbation and renal impairment may be beneficial in preserving kidney function. US provides a simple easily accessible tool to guide the management of patients with HF.
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Yamanoglu A, Celebi Yamanoglu NG, Ozturk S, Cakmak S, Akay S, Akyol PY, Sogut O. The value of the inferior vena cava ultrasound in the decision to hospitalise in patients with acute decompensated heart failure; the best sonographic measurement method? Acta Cardiol 2021; 76:245-257. [PMID: 32189575 DOI: 10.1080/00015385.2020.1740422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The primary aim of this study was to determine the value of the inferior vena cava (IVC) ultrasound in the decision to hospitalise acute decompensated heart failure (ADHF) patients. Our secondary aim was to find the most successful IVC measurement method in monitoring volume status. METHODS ADHF patients were accepted over a 1-year period in this study. Patients' vital signs, laboratory tests and IVC measurements measured by six methods (in B- and M-mode; maximum, minimum diameter and caval index) performed on an hourly basis were recorded. The presence of any statistically significant difference between the IVC measurement methods, laboratory tests and vital parameters between the hospitalised and discharged patients was calculated. ROC curves were produced in order to determine the ability of parameters to differentiate two groups. Spearman's correlation test was used to investigate correlation between the IVC measurement methods and patients' urine outputs. RESULTS A total of 71 patients were included in the study; 42 of these were hospitalised and 29 were discharged. Potassium, brain natriuretic peptide, respiration rate, urine output, maximum and minimum IVC diameters differed significantly between the two groups. Minimum IVC diameter measured in M-mode was identified as a weak marker with 65% sensitivity and 64% specificity (+PPV: 73%; -NPV:54%) for hospitalisation. Change in maximum IVC diameter measured in B-mode exhibited a high degree of correlation with change in body fluid (cc: 0.802). CONCLUSION IVC ultrasound may have a limited value in the decision to hospitalise ADHF patients. But Maximum IVC diameter may be an ideal method for monitoring hypervolemic patients' volume status. CLINICAL TRIALS IDENTIFIER NCT02725151.
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Affiliation(s)
- Adnan Yamanoglu
- Department of Emergency Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Nalan Gokce Celebi Yamanoglu
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Semi Ozturk
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sumeyye Cakmak
- Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serhat Akay
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Pınar Yesim Akyol
- Department of Emergency Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Ozgur Sogut
- Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Suarez J, Niyyar VD. Lung Ultrasound: A "Biomarker" for Fluid Overload? Adv Chronic Kidney Dis 2021; 28:200-207. [PMID: 34906304 DOI: 10.1053/j.ackd.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 11/11/2022]
Abstract
Fluid overload is associated with poor outcomes in patients with acute kidney injury as well as end-stage kidney disease. Lung ultrasound (LUS) has been used in many different settings and specialties including the emergency department, intensive care unit, trauma, cardiology, and nephrology. Although LUS has been a valuable tool in assessing pulmonary congestion, LUS findings may not always be pathognomonic for pulmonary congestion. Furthermore, the feasibility of doing an extensive LUS examination as has been done in research studies may be hard to implement within the clinical setting. This review will go over the use of LUS to evaluate for fluid overload, compare LUS with other markers of fluid overload, review limitations of LUS, and suggest potential future directions in the use of LUS in nephrology.
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The place of inferior vena cava diameter and proBNP levels in determining the fluid balance of medical intensive care patients. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.858649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Takagi K, Sato N, Ishihara S, Iha H, Kobayashi N, Ito Y, Nohara T, Ohkuma S, Mitsuishi T, Ishizuka A, Shigihara S, Sone M, Nakama K, Tokuyama H, Omote T, Kikuchi A, Nakamura S, Yamamoto E, Ishikawa M, Amitani K, Takahashi N, Maruyama Y, Imura H, Shimizu W. Differences in pharmacological property between combined therapy of the vasopressin V2-receptor antagonist tolvaptan plus furosemide and monotherapy of furosemide in patients with hospitalized heart failure. J Cardiol 2020; 76:499-505. [PMID: 32665162 DOI: 10.1016/j.jjcc.2020.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/07/2020] [Accepted: 05/07/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Tolvaptan has been shown to improve congestion in heart failure patients. The purpose of this study was to evaluate the pharmacology and clinical efficacy of combined tolvaptan and furosemide therapy. METHODS This study included 40 patients with systemic volume overload who were hospitalized for heart failure. Patients who showed no improvement in the condition after receiving 20 mg intravenous furosemide were included and were randomly selected to receive tolvaptan as an add-on to furosemide or to receive an increased dose of furosemide. We evaluated the bioelectrical impedance analyzer parameters, the parameters of the inferior vena cava using echocardiography, vital signs, body weight, urine output, and laboratory data for 5 days. RESULTS In the changes from baseline between intracellular water volume (ICW) and extracellular water volume (ECW) after additional use of tolvaptan or furosemide from Day 1 to Day 5, there were no significant differences observed between ICW and ECW over 5 days in the tolvaptan + furosemide group, although differences were found in the furosemide group from Day 2 onward. Changes in the respiratory collapse of inferior vena cava increased significantly, and systolic blood pressure decreased significantly only in the furosemide group. CONCLUSIONS The present study clearly demonstrates that combined therapy with tolvaptan and furosemide removed excess ICW and ECW to an equal extent, while furosemide alone primarily removed ECW, including intravascular water.
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Affiliation(s)
- Koji Takagi
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan.
| | - Shiro Ishihara
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Hayano Iha
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Noriyuki Kobayashi
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Yusuke Ito
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Tsuyoshi Nohara
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Satoru Ohkuma
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Tatsuya Mitsuishi
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Atsushi Ishizuka
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Shota Shigihara
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Michiko Sone
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Kenji Nakama
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Hideo Tokuyama
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Toshiya Omote
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Arifumi Kikuchi
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Shunichi Nakamura
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Eisei Yamamoto
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Masahiro Ishikawa
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Kenichi Amitani
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Naoto Takahashi
- Cardiology and Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Yuji Maruyama
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Hajime Imura
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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14
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Darwish OS, Mahayni A, Kataria S, Zuniga E, Zhang L, Amin A. Diagnosis of Acute Heart Failure Using Inferior Vena Cava Ultrasound: Systematic Review and Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1367-1378. [PMID: 31985108 DOI: 10.1002/jum.15231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/12/2019] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The utility of bedside inferior vena cava (IVC) ultrasound (US) in the diagnosis of heart failure (HF) is unclear. The aim of this study was to determine whether IVC parameters in patients with acute heart failure (AHF) are statistically different from those without HF. METHODS The MEDLINE database of English-language publications from 1966 to August 2018 was searched. Retrospective and prospective studies that included either IVC expiratory diameter (IVCexp ) or IVC collapsibility index (IVC-CI) values were collected in patients with and without HF. to determine whether there was a statistical difference in the IVC parameters between these groups. RESULTS A total of 27 articles with a total of 1472 patients with AHF were included. The standard mean differences for the IVCexp and IVC-CI for the control group versus the AHF group were found to be statistically significant (P < .0001). The combined mean IVCexp values were 15.11 mm (95% confidence interval [CI], 14.19-16.02 mm) for the control group and 20.26 mm (95% CI, 14.82-25.71 mm) for the AHF group. The combined mean IVC-CI values were 61.6% (95% CI, 48.4%-74.7%) for the control group and 30.5% (95% CI, 26.4%-34.6%) for the AHF group. CONCLUSIONS Bedside IVC US showed that a statistically significant difference existed in the IVC parameters between patients with and without AHF. Based on mean calculations, an IVCexp of greater than 2.0 cm and an IVC-CI of less than 30% are reasonable cutoffs to suggest that a patient with acute dyspnea is more likely to have AHF than a non-AHF condition. Given the high degree of heterogeneity across the studies and the high risk of bias, larger randomized studies are warranted to explore the use of IVC US in patients with HF.
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Affiliation(s)
- Omar S Darwish
- University of California Irvine Medical Center, Orange, California, USA
| | - Abdullah Mahayni
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Eric Zuniga
- University of California Medical School, Irvine, California, USA
| | - Lishi Zhang
- University of California, Irvine, California, USA
| | - Alpesh Amin
- University of California, Irvine, California, USA
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15
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Khan A, Khan D, Shadi M, MacDougall K, Lafferty J. Utilization of Ultrasound to Assess Volume Status in Heart Failure. J Clin Med Res 2020; 12:230-232. [PMID: 32362970 PMCID: PMC7188367 DOI: 10.14740/jocmr4049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) represents a significant financial burden to the US health care system, affecting approximately 5.7 million Americans. By 2030, the prevalence of HF is expected to increase by 23%. Clinicians generally evaluate volume status in patients with HF by visualizing jugular venous distension to estimate right atrial pressure; a method with an estimated accuracy of only 50%. Currently, the only endorsed methods for acute HF diagnosis in the 2017 American College of Cardiology (ACC) guidelines are brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP), pre-discharge BNP or NT-proBNP, and myocardial fibrosis markers. However, serial testing of BNP to monitor therapy remains controversial. Moreover, an elevated BNP cannot be attributed solely to a cardiac cause. Given the limitations of the current methods, a robust tool is needed to reliably assess volume status in HF patients. It is now known that hemodynamic congestion from increases in intracardiac pressure occurs days to weeks prior to the onset of typical HF symptoms, such as weight gain and shortness of breath. It has been postulated that assessing the inferior vena cava (IVC) diameter with a portable ultrasound, may be the simple, reliable, and cost-effective method of evaluating right atrial pressure, and thus, the severity of HF. Given this exciting new tool in assessing volume status in patients with HF, we pose the question of whether this imaging modality can be used to risk-stratify patients and guide management. The aim of this paper is to highlight the many benefits of portable ultrasound in assessing volume status in this population, and to discuss whether this imaging modality can help guide physicians in the management of their HF patients.
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Affiliation(s)
- Asif Khan
- Department of Cardiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Danyal Khan
- Department of Cardiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Mahmoud Shadi
- Department of Cardiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Kira MacDougall
- Department of Cardiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - James Lafferty
- Department of Cardiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA
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16
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Mozzini C, Soresi M, Pesce G, Girelli D. A Five-Step Vascular Ultrasound Examination in Heart Failure: The First Two Years of the "ABCDE" G-SIUMB Multicenter Study 2018-2022. Curr Probl Cardiol 2020; 46:100578. [PMID: 32276739 DOI: 10.1016/j.cpcardiol.2020.100578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 01/07/2023]
Abstract
The aim of this study is the creation of a 5-step ultrasound examination to evaluate and monitor Heart Failure (HF) patients during hospitalization and follow-up. "ABCDE" is the acronym of an Italian multicentre study composed of a consecutive sample of HF patients admitted from the Emergency to the Internal Medicine/Geriatric Departments of several Italian hospitals. The "ABCDE" score includes the evaluations of A, the Ankle-brachial index (ABI), B, the B-lines, C, the Carotid intima media thickness (CIMT), D, the Diameter of the abdominal aorta and of the inferior cave vein and E, the echocardiographic assessment of the ejection fraction. This paper reports the preliminary results. Up to now, the "ABCDE" multicenter study seems an exciting opportunity to create an integrative ultrasound approach in HF. The definitive confirmation of these preliminary results and the effective usefulness of the "ABCDE" will be available in 2022, at the end of the study.
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17
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Patnaik S, Davila CD, Lu M, Alhamshari Y, Shah M, Jorde UP, Pressman GS, Banerji S. Clinical correlates of hand-held ultrasound-guided assessments of the inferior vena cava in patients with acute decompensated heart failure. Echocardiography 2019; 37:22-28. [PMID: 31786825 DOI: 10.1111/echo.14551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/25/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Accurately assessing volume status in acutely decompensated heart failure (ADHF) can be challenging. Inferior vena cava (IVC) dynamics by echocardiography allow indirect assessment of volume status in these patients. Recently introduced hand-held ultrasound devices are promising. We aimed to describe the clinical correlates of volume status assessment using a hand-held ultrasound device in ADHF. METHODS In this prospective study, we evaluated 106 patients admitted with ADHF. First scan was performed within 24 hours of admission and timed in reference to first dose of intravenous diuretic. Daily resting and inspiratory (sniff) IVC diameters were measured according to standard echocardiography methods during hospitalization including the day of discharge. IVC collapsibility index (IVC-CI = Maximum IVC diameter-Inspiratory IVC diameter/maximum diameter; <0.5 representing hypervolemia) was calculated. Primary study endpoint was 30-day readmission. Research activities were independent of clinical decision-making. RESULTS Data for 106 patients was analyzed. Mean age was 66.7 ± 13.8 years, of which 53.8% were females, and a mean ejection fraction was 39 ± 18%. Initial scan of the IVC was obtained at an average time of 5.2 ± 8.04 hours from first diuretic dose. 81.2% of patients at admission had an IVC-CI <0.5. 63.2% patients had an IVC-CI <0.5 at discharge. There were no significant differences in age, length of stay, diuretic dose, or 30-day readmissions between patients with a discharge IVC-CI <0.5 vs ≥ 0.5. CONCLUSION Hand-held ultrasound assessment of IVC-CI in ADHF patients, although a feasible concept, is unable to predict 30-day readmissions in our study. Further prospective studies are necessary.
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Affiliation(s)
- Soumya Patnaik
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Carlos D Davila
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Marvin Lu
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Yaser Alhamshari
- Division of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Mahek Shah
- Division of Cardiology, Montefiore Medical Center, New York City, New York
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, New York City, New York
| | - Gregg S Pressman
- Division of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Sourin Banerji
- Division of Cardiology, Christiana Care Health System, Newark, Delaware
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18
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Arvig MD, Laursen CB, Jacobsen N, Gæde PH, Lassen AT. Effectiveness of serial focused ultrasound of the lungs and inferior vena cava for monitoring patients with acute dyspnea: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:2317-2325. [PMID: 31290795 DOI: 10.11124/jbisrir-d-19-00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The objective of this review is to evaluate the effectiveness of serial focused ultrasound of the lungs (FLUS) and/or inferior vena cava (IVC) compared to standard care for monitoring patients with acute dyspnea. INTRODUCTION Acute dyspnea is one of the most common complaints reported by patients in hospital emergency departments, and has high in-hospital mortality rates. The current methods of monitoring patients with acute dyspnea lack both sensitivity and specificity. Point-of-care FLUS and IVC is a promising monitoring tool, but an overview of the existing evidence is absent. INCLUSION CRITERIA This review will include studies of adult patients admitted to hospital with acute dyspnea that is examined via FLUS, IVC or both a minimum of twice during hospitalization compared to standard care. METHODS The following electronic databases will be searched: PubMed, Cochrane, Embase, Scopus, Web of Science and Google Scholar. Gray literature will be sought in OpenGrey and ProQuest. The search is limited to articles written in English, Danish, Swedish, Norwegian and German. Articles published before 2003 will be excluded from the search and duplicates will be removed. Two independent reviewers will screen and critically appraise the included studies and perform the data extraction. If possible, data will be synthesized with statistical meta-analysis; otherwise, data will be presented in narrative form. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018116608.
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Affiliation(s)
- Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Jacobsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Regional Center for Technical Simulation, TechSim, Odense, Denmark
| | - Peter Haulund Gæde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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19
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Curbelo J, Rodriguez-Cortes P, Aguilera M, Gil-Martinez P, Martín D, Suarez Fernandez C. Comparison between inferior vena cava ultrasound, lung ultrasound, bioelectric impedance analysis, and natriuretic peptides in chronic heart failure. Curr Med Res Opin 2019; 35:705-713. [PMID: 30185067 DOI: 10.1080/03007995.2018.1519502] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Heart failure (HF) is an important healthcare problem. Knowing volume status in outpatients with chronic HF to adjust treatment and to avoid decompensations is a challenge. The aim of this study is comparing the usefulness of inferior vena cava (IVC) ultrasound, lung ultrasound, bioelectrical impedance analysis (BIA), and natriuretic peptides in the follow-up of outpatients with chronic HF. METHODS This was a prospective cohort study. Ninety-nine patients with chronic HF were included consecutively as they attended scheduled medical visits. The different techniques were performed on the day of the clinic visit, and the result was hidden from the patients and the responsible medical team. Follow-up time was 1 year. Outcome events checked were a combination of death or hospitalization, due to HF. RESULTS Thirty-six patients (36.4%) died or were hospitalized for HF. They had a significantly lower IVC collapse, and a greater number of lung B-lines and higher NTproBNP levels compared to patients who remained stable. There were no differences in the BIA parameters. After multivariable analysis, cut-off points of IVC collapse <30%, number of pulmonary B lines greater than 5, and NTproBNP levels greater than 2000 pg/ml were associated with increased risk of HF death or admission. NTproBNP had the best area under the curve. CONCLUSION Evaluation of congestion in outpatients with chronic HF may be based on NTproBNP, IVC ultrasound, or lung ultrasound; they are useful in identifying patients at high risk of hospitalization or death due to HF.
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Affiliation(s)
- Jose Curbelo
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Pablo Rodriguez-Cortes
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Maria Aguilera
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Paloma Gil-Martinez
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Daniel Martín
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Carmen Suarez Fernandez
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
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20
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Mozzini C, Cominacini L, Casadei A, Schiavone C, Soresi M. Ultrasonography in Heart Failure: A Story that Matters. Curr Probl Cardiol 2019; 44:116-136. [PMID: 30172551 DOI: 10.1016/j.cpcardiol.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 02/07/2023]
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21
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Kaptein MJ, Kaptein JS, Oo Z, Kaptein EM. Relationship of inferior vena cava collapsibility to ultrafiltration volume achieved in critically ill hemodialysis patients. Int J Nephrol Renovasc Dis 2018; 11:195-209. [PMID: 30087575 PMCID: PMC6061398 DOI: 10.2147/ijnrd.s165744] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Ultrasound (US) assessment of intravascular volume may improve volume management of dialysis patients. We investigated the relationship of intravascular volume evaluated by inferior vena cava (IVC) US to net volume changes with intermittent hemodialysis (HD) in critically ill patients. Methods A retrospective cohort of 113 intensive care unit patients in 244 encounters had clinical assessment of intravascular volume followed by US of respiratory/ventilatory variation of IVC diameter, and had HD within 24 h. IVC collapsibility index (IVC CI)=(IVCmax–IVCmin)/IVCmax*100%. Volume management was guided by clinical data plus IVC US findings. Intradialytic hypotension (IDH) was categorized by severity from none to inability to tolerate HD. Results Linear regression correlating n-weighted proportions of encounters achieving net volume removal of ≥0.5 L, ≥1.0 L, ≥1.5 L, and ≥2.0 L strongly correlated across the range of IVC CI (R2=0.87–0.64). Sensitivity and specificity analysis showed IVC CI was a better predictor than IVCmax of achieving net ultrafiltration (UF) volumes. Mean central venous pressure, pulmonary artery occlusion pressure, and cardiac output were poor predictors by logistic regression and receiver operating curve analyses. IVC CI <20% was the approximate optimal cutoff for achieving ≥0.5 L to ≥2.0 L net UF volumes. Net volume change achieved tended to be less than recommended and may have been limited by the development of IDH. Severity of IDH did not correlate with UF rate in mL/kg/h. χ2 analysis showed pre-US clinical intravascular volume assessments had poor concordance with IVC CI categories. Conclusion IVC US may be a useful tool for predicting whether critically ill patients will achieve volume removal with HD.
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Affiliation(s)
- Matthew J Kaptein
- Division of Nephrology, Loma Linda University Medical Center, Loma Linda, CA, USA.,Division of Nephrology, University of Southern California, Los Angeles, CA, USA,
| | - John S Kaptein
- Division of Nephrology, University of Southern California, Los Angeles, CA, USA,
| | - Zayar Oo
- Division of Nephrology, University of Southern California, Los Angeles, CA, USA,
| | - Elaine M Kaptein
- Division of Nephrology, University of Southern California, Los Angeles, CA, USA,
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22
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Laffin LJ, Bakris GL. Results of ACCORDIAN in ACCORD with lower blood pressure begetting lower mortality in patients with diabetes. Diabetes Obes Metab 2018; 20:1335-1336. [PMID: 29424470 PMCID: PMC5948152 DOI: 10.1111/dom.13249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 01/05/2023]
Abstract
Acute decompensated heart failure (ADHF) is a common reason for admission to the hospital, and readmission is frequent. Multiple factors contribute to rehospitalizations, but inadequate assessment of volume status leading to persistent congestion is an important factor. We sought to determine if focused cardiac ultrasound (FCU) of the inferior vena cava (IVC), as a surrogate of volume status, would predict readmission of ADHF patients after index hospitalization. Patients admitted with a primary diagnosis of ADHF were prospectively enrolled. All patients underwent FCU of the IVC on admission and then daily. 82 patients were enrolled. Patients demonstrated improvement in heart failure physical examination findings and symptoms during the hospitalization. There was a reduction in the size of the IVC and a significant increase in patients with small collapsible vena cava. Logistic regression analysis of physical examination, patient symptoms, and IVC parameters at discharge demonstrated IVC collapsibility and patient reported dyspnea improvement as the only significant variables to predict readmission or emergency department visit. FCU assessment of IVC size and collapsibility may be useful in patients with ADHF to predict risk of being readmitted within 30 days of hospital discharge.
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Affiliation(s)
- Luke J Laffin
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
- ASH Comprehensive Hypertension Center, Section of Endocrinology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - George L Bakris
- ASH Comprehensive Hypertension Center, Section of Endocrinology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
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23
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Curbelo J, Aguilera M, Rodriguez-Cortes P, Gil-Martinez P, Suarez Fernandez C. Usefulness of inferior vena cava ultrasonography in outpatients with chronic heart failure. Clin Cardiol 2018; 41:510-517. [PMID: 29664116 DOI: 10.1002/clc.22915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Inferior vena cava (IVC) ultrasonography has been used for the diagnosis and prognosis of acute heart failure (HF). Its usefulness in chronic HF is less known. HYPOTHESIS IVC ultrasonography is a useful tool in the care of patients with chronic HF. METHODS For this prospective cohort study, 95 patients with chronic HF were included consecutively as they attended scheduled medical visits. Ultrasound was done with a 5-MHz convex probe device, calculating IVC collapse index (IVCCI). Follow-up time was 1 year. Outcome events were worsening HF, hospital admission for HF, HF mortality, and all-cause mortality. RESULTS Worsening HF occurred in 70.9% of patients with IVCCI <30% and 39.1% of patients with IVCCI >50%, with a hazard ratio (HR) of 2.8 (95% CI: 1.3-6.2) adjusted by multivariable analysis. Regarding hospitalization, 45.3% of patients with IVCCI <30% required admission, compared with 5.9% of patients with IVCCI >50%; the adjusted HR was 13.9 (95% CI: 1.7-113.0). Mortality was higher in the IVCCI <30% group, with 25.7% all-cause mortality and 18.6% HF mortality, whereas in the IVCCI >50% group these values were 13% and 4.7%, respectively. However, these differences did not reach statistical significance. ROC analysis was performed and the AUC for IVCCI was not higher than that for NTproBNP for any of the outcomes studied. CONCLUSIONS IVC ultrasonography is a useful tool in follow-up of patients with chronic HF, allowing identification of patients at high risk of worsening and hospitalization. However, its usefulness is not higher than that of NTproBNP.
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Affiliation(s)
- Jose Curbelo
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Aguilera
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pablo Rodriguez-Cortes
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Paloma Gil-Martinez
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Suarez Fernandez
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
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24
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Laffin LJ, Patel AV, Saha N, Barbat J, Hall JK, Cain M, Parikh K, Shah J, Spencer KT. Focused cardiac ultrasound as a predictor of readmission in acute decompensated heart failure. Int J Cardiovasc Imaging 2018; 34:1075-1079. [PMID: 29450742 DOI: 10.1007/s10554-018-1317-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/07/2018] [Indexed: 01/15/2023]
Abstract
Acute decompensated heart failure (ADHF) is a common reason for admission to the hospital, and readmission is frequent. Multiple factors contribute to rehospitalizations, but inadequate assessment of volume status leading to persistent congestion is an important factor. We sought to determine if focused cardiac ultrasound (FCU) of the inferior vena cava (IVC), as a surrogate of volume status, would predict readmission of ADHF patients after index hospitalization. Patients admitted with a primary diagnosis of ADHF were prospectively enrolled. All patients underwent FCU of the IVC on admission and then daily. 82 patients were enrolled. Patients demonstrated improvement in heart failure physical examination findings and symptoms during the hospitalization. There was a reduction in the size of the IVC and a significant increase in patients with small collapsible vena cava. Logistic regression analysis of physical examination, patient symptoms, and IVC parameters at discharge demonstrated IVC collapsibility and patient reported dyspnea improvement as the only significant variables to predict readmission or emergency department visit. FCU assessment of IVC size and collapsibility may be useful in patients with ADHF to predict risk of being readmitted within 30 days of hospital discharge.
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Affiliation(s)
- Luke J Laffin
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6080, Chicago, IL, 60622, USA
| | - Amit V Patel
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6080, Chicago, IL, 60622, USA
| | - Narayan Saha
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6080, Chicago, IL, 60622, USA
| | - Julian Barbat
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6080, Chicago, IL, 60622, USA
| | - James K Hall
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6080, Chicago, IL, 60622, USA
| | - Matthew Cain
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6080, Chicago, IL, 60622, USA
| | - Kishan Parikh
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6080, Chicago, IL, 60622, USA
| | - Jay Shah
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6080, Chicago, IL, 60622, USA
| | - Kirk T Spencer
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 6080, Chicago, IL, 60622, USA.
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25
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Is the Collapsibility Index of the Inferior Vena Cava an Accurate Predictor for the Early Detection of Intravascular Volume Change? Shock 2018; 49:29-32. [DOI: 10.1097/shk.0000000000000932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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26
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Dynamic Limb Bioimpedance and Inferior Vena Cava Ultrasound in Patients Undergoing Hemodialysis. ASAIO J 2017; 62:463-9. [PMID: 26919184 DOI: 10.1097/mat.0000000000000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Assessment of volume status in critically ill patients poses a challenge to clinicians. Measuring changes in the inferior vena cava (IVC) diameter using ultrasound is becoming a standard tool to assess volume status. Ultrasound requires physicians with significant training and specialized expensive equipment. It would be of significant value to be able to obtain this measurement continuously without physician presence. We hypothesize that dynamic changes in limb's bioimpedance in response to respiration could be used to predict changes in IVC. Forty-six subjects were tested a hemodialysis session. Impedance was measured via electrodes placed on the arm. Simultaneously, the IVC diameter was assessed by ultrasound. Subjects were asked to breathe spontaneously and perform respiratory maneuvers using a respiratory training device. Impedance (dz) was determined and compared with change in IVC diameter (dIVC; r = 0.76, p < 0.0001). There was significant relationship between dz and dIVC (p< 0.0001). Receiver-operator curves for dz at thresholds of dIVC (20% to70%) demonstrated high predictive power with areas under the curves (0.87-0.99, p < 0.0001). This evaluation suggests that real-time dynamic changes in limb impedance are capable of tracking a wide range of dynamic dIVC. This technique might be a suitable surrogate for monitoring real-time changes in dIVC to assess intravascular volume status.
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Ilyas A, Ishtiaq W, Assad S, Ghazanfar H, Mansoor S, Haris M, Qadeer A, Akhtar A. Correlation of IVC Diameter and Collapsibility Index With Central Venous Pressure in the Assessment of Intravascular Volume in Critically Ill Patients. Cureus 2017; 9:e1025. [PMID: 28348943 PMCID: PMC5346017 DOI: 10.7759/cureus.1025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective The objective of our study is to assess the correlation between inferior vena cava (IVC) diameters, central venous pressure (CVP) and the IVC collapsibility index for estimating the volume status in critically ill patients. Methods This cross-sectional study used the convenient sampling of 100 adult medical intensive care unit (ICU) patients for a period of three months. Patients ≥ 18 years of age with an intrathoracic central venous catheter terminating in the distal superior vena cava connected to the transducer to produce a CVP waveform were included in the study. A Mindray diagnostic ultrasound system model Z6 ultrasound machine (Mindray, NJ, USA) was used for all examinations. An Ultrasonic Transducer model 3C5P (Mindray, NJ, USA) for IVC imaging was utilized. A paired sampled t-test was used to compute the p-values. Results A total of 32/100 (32%) females and 68/100 (68%) males were included in the study with a mean age of 50.4 ± 19.3 years. The mean central venous pressure maintained was 10.38 ± 4.14 cmH2O with an inferior vena cava collapsibility index of 30.68 ± 10.93. There was a statistically significant relation among the mean CVP pressure, the IVC collapsibility index, the mean maximum and minimum IVC between groups as determined by one-way analysis of variance (ANOVA) (p < 0.001). There was a strong negative correlation between CVP and IVC collapsibility index (%), which was statistically significant (r = -0.827, n = 100, p < 0.0005). A strong positive correlation between CVP and maximum IVC diameter (r = 0.371, n = 100, p < 0.0005) and minimum IVC diameter (r = 0.572, n = 100, p < 0.0005) was found. Conclusion There is a positive relationship of CVP with minimum and maximum IVC diameters but an inverse relationship with the IVC collapsibility index.
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Affiliation(s)
- Abid Ilyas
- Internal Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | - Wasib Ishtiaq
- Department of Pulmonology & Critical Care Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Salman Assad
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Haider Ghazanfar
- Department of Neurology, Shifa International Hospital, Islamabad, Pakistan
| | - Salman Mansoor
- Department of Neurology, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Haris
- Department of Cardiology, Shifa College of Medicine, Islamabad, Pakistan
| | - Aayesha Qadeer
- Department of Pulmonology & Critical Care Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Aftab Akhtar
- Department of Pulmonology & Critical Care Medicine, Shifa International Hospital, Islamabad, Pakistan
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28
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Inferior vena cava collapsibility index, renal dysfunction, and adverse outcomes in patients with broad spectrum cardiovascular disease. Echocardiography 2017; 34:20-28. [DOI: 10.1111/echo.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/22/2016] [Accepted: 10/05/2016] [Indexed: 12/01/2022] Open
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29
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Agra RM, Al-Daghri NM, Badimon L, Bodi V, Carbone F, Chen M, Cubedo J, Dullaart RPF, Eiras S, García-Monzón C, Gary T, Gnoni A, González-Rodríguez Á, Gremmel T, Hafner F, Hakala T, Huang B, Ickmans K, Irace C, Kholová I, Kimer N, Kytö V, März W, Miazgowski T, Møller S, Montecucco F, Niccoli G, Nijs J, Ozben S, Ozben T, Papassotiriou I, Papastamataki M, Reina-Couto M, Rios-Navarro C, Ritsch A, Sabico S, Seetho IW, Severino A, Sipilä J, Sousa T, Taszarek A, Taurino F, Tietge UJF, Tripolino C, Verloop W, Voskuil M, Wilding JPH. Research update for articles published in EJCI in 2014. Eur J Clin Invest 2016; 46:880-94. [PMID: 27571922 DOI: 10.1111/eci.12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Rosa María Agra
- Department of Cardiology and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Nasser M Al-Daghri
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Lina Badimon
- Cardiovascular Research Center (CSIC-ICCC), Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Cardiovascular Research Chair, UAB, Barcelona, Spain
| | - Vicente Bodi
- Cardiology Department, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain
| | - Federico Carbone
- First Clinical of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Judit Cubedo
- Cardiovascular Research Center (CSIC-ICCC), Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sonia Eiras
- Health Research Institute, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmelo García-Monzón
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBEREHD, Madrid, Spain
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Antonio Gnoni
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Águeda González-Rodríguez
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBEREHD, Madrid, Spain
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Baotao Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kelly Ickmans
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Concetta Irace
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Nina Kimer
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Augsburg, Germany
| | - Tomasz Miazgowski
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Fabrizio Montecucco
- First Clinical of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS AOU San Martino-IST, Genoa, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | | | - Jo Nijs
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Serkan Ozben
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Tomris Ozben
- Department of Medical Biochemistry, Medical Faculty, Akdeniz University, Antalya, Turkey
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Maria Papastamataki
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Marta Reina-Couto
- Departamento de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,MedInUP - Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto, Porto, Portugal.,Departamento de Medicina Intensiva, Centro Hospitalar São João, Porto, Portugal
| | - Cesar Rios-Navarro
- Cardiology Department, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain
| | - Andreas Ritsch
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Shaun Sabico
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ian W Seetho
- Obesity and Endocrinology Research Group, University Hospital Aintree, University of Liverpool, Liverpool, UK
| | | | - Jussi Sipilä
- North Karelia Central Hospital, Joensuu, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Teresa Sousa
- Departamento de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,MedInUP - Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto, Porto, Portugal
| | - Aleksandra Taszarek
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Federica Taurino
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Uwe J F Tietge
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cesare Tripolino
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Willemien Verloop
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - John P H Wilding
- Obesity and Endocrinology Research Group, University Hospital Aintree, University of Liverpool, Liverpool, UK
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New ways to visualize and combat congestion in heart failure. Rev Clin Esp 2016; 216:202-4. [PMID: 27129360 DOI: 10.1016/j.rce.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 11/20/2022]
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31
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Mirabel M, Celermajer D, Beraud AS, Jouven X, Marijon E, Hagège AA. Pocket-sized focused cardiac ultrasound: strengths and limitations. Arch Cardiovasc Dis 2015; 108:197-205. [PMID: 25747662 DOI: 10.1016/j.acvd.2015.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 10/23/2022]
Abstract
Focused cardiac ultrasound (FCU) has emerged in recent years and has created new possibilities in the clinical assessment of patients both in and out of hospital. The increasing portability of echocardiographic devices, with some now only the size of a smartphone, has widened the spectrum of potential indications and users, from the senior cardiologist to the medical student. However, many issues still need to be addressed, especially the acknowledgment of the advantages and limitations of using such devices for FCU, and the extent of training required in this rapidly evolving field. In recent years, an increasing number of studies involving FCU have been published with variable results. This review outlines the evidence for the use of FCU with pocket-echo to address specific questions in daily clinical practice.
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Affiliation(s)
- Mariana Mirabel
- Assistance publique-Hôpitaux de Paris, hôpital Européen-Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Centre-PARCC, 75737 Paris Cedex 15, France.
| | | | - Anne-Sophie Beraud
- Stanford University Hospital, Stanford, CA, USA; Clinique Pasteur, 31300 Toulouse, France
| | - Xavier Jouven
- Assistance publique-Hôpitaux de Paris, hôpital Européen-Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Centre-PARCC, 75737 Paris Cedex 15, France
| | - Eloi Marijon
- Assistance publique-Hôpitaux de Paris, hôpital Européen-Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Centre-PARCC, 75737 Paris Cedex 15, France
| | - Albert A Hagège
- Assistance publique-Hôpitaux de Paris, hôpital Européen-Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Centre-PARCC, 75737 Paris Cedex 15, France
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