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Herkert C, De Lathauwer I, van Leunen M, Spee RF, Balali P, Migeotte P, Hossein A, Lu Y, Kemps HMC. The kinocardiograph for assessment of fluid status in patients with acute decompensated heart failure. ESC Heart Fail 2023; 10:3446-3453. [PMID: 37710415 PMCID: PMC10682902 DOI: 10.1002/ehf2.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS To improve telemonitoring strategies in heart failure patients, there is a need for novel non-obtrusive sensors that monitor parameters closely related to intracardiac filling pressures. This proof-of-concept study aims to evaluate the responsiveness of cardiac kinetic energy (KE) measured with the Kinocardiograph (KCG), consisting of a seismocardiographic (SCG) sensor and a ballistocardiographic (BCG) sensor, during treatment of patients with acute decompensated heart failure. METHODS AND RESULTS Eleven patients with acute decompensated heart failure who were hospitalized for treatment with intravenous diuretics received daily KCG measurements. The KCG measurements were compared with the diameter of the inferior vena cava (IVC) and body weight. Follow-up stopped at discharge, that is, in the recompensated state. Median (interquartile range) weight and IVC diameter decreased significantly after diuretic treatment [weight 74.5 (67.6-98.7) to 73.3 (66.7-95.6) kg, P = 0.003; IVC diameter 2.47 (2.33-2.99) to 1.78 (1.65-2.47) cm, P = 0.03]. In contrast with BCG measurements, significant changes in median KE measured with SCG were observed during the passive filling phase of the diastole [SGG: 0.48 (0.39-0.60) to 0.69 (0.56-0.84), P = 0.026; BCG: 0.68 (0.46-0.73) to 0.68 (0.59-0.82), P = 0.062], the active filling phase of the diastole [SCG: 0.38 (0.30-0.61) to 0.31 (0.09-0.47), P = 0.016; BCG: 0.29 (0.17-0.39) to 0.26 (0.20-0.34), P = 0.248], and the ratio between the passive and active filling phases [SCG: 2.76 (1.68-5.30) to 5.02 (3.13-10.17), P = 0.006; BCG: 5.87 (3.57-7.55) to 5.27 (3.95-9.43), P = 0.790]. The correlations between changes in KE during the passive and active filling phases, using SCG, and changes in weight or IVC were non-significant. Systolic KE did not show significant changes. CONCLUSION KE measured with the KCG using SCG is highly responsive to changes in fluid status. Future research is needed to confirm its accuracy in a larger study population and specifically its application for detection of clinical deterioration in the home-environment.
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Affiliation(s)
- Cyrille Herkert
- Department of CardiologyMáxima Medical CentreEindhovenThe Netherlands
| | | | - Mayke van Leunen
- Department of CardiologyMáxima Medical CentreEindhovenThe Netherlands
| | | | - Paniz Balali
- LPHYSUniversité Libre de BruxellesBrusselsBelgium
| | | | - Amin Hossein
- LPHYSUniversité Libre de BruxellesBrusselsBelgium
| | - Yuan Lu
- Department of Industrial DesignEindhoven University of TechnologyEindhovenThe Netherlands
| | - Hareld Marijn Clemens Kemps
- Department of CardiologyMáxima Medical CentreEindhovenThe Netherlands
- Department of Industrial DesignEindhoven University of TechnologyEindhovenThe Netherlands
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Torres-Arrese M, Mata-Martínez A, Luordo-Tedesco D, Casasola-Sánchez GG, Montero-Hernández E, Cobo-Marcos M, Tejeda-Jurado F, Berrocal-Espinosa P, Martínez-Ballester JF, Tung-Chen Y. Role of the Femoral Vein Doppler in Acute Heart Failure Patients: results from a prospective multicentric study. Rev Clin Esp 2023:S2254-8874(23)00054-1. [PMID: 37088380 DOI: 10.1016/j.rceng.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of our study is to define the role of Pulsed-Doppler (PW-Doppler) Ultrasound of the Common Femoral Vein (CFV) in the assessment of dilatation Inferior Vena Cava (IVC), probability of Pulmonary Hypertension (PH), Tricuspid Regurgitation (TR), and Tricuspid annular plane systolic excursion (TAPSE). METHODS This is a prospective two-hospital study in 74 patients admitted with acute heart failure (AHF). We performed PW-Doppler ultrasound of the common femoral vein, Point of Care (POC) cardiac ultrasonography and assessment of the IVC at the time of admission, as well as PW-Doppler and ultrasound of the IVC at hospital discharge. RESULTS The detection of a pulsatile flow (138 scans) had an excellent ROC curve for the detection of IVC greater than 2 cm (AUC 0.931, Sn 95%, Sp 90%, PPV 93%, NPV 94%) with an Odds Ratio (OR) of 211.2 (95% confidence interval 48.13-926.72). The pulsatility of the flow also had the highest performance in the detection of PH (AUC 0.8, Sn 95%, Sp 64%, PPV 84%, NPV 84%) and in the detection of moderate-severe TR (AUC 0.79, Sn 95%, Sp 67%, PPV 88%, NPV 78%). If the flow is continuous, we can reasonably rule out diminished TAPSE (NPV 89%). CONCLUSSION Detection of PW-Doppler flow of the CFV may be an alternative window for the detection of an IVC dilation of 2 cm, significant TR, and the likelihood of high PH in acute heart failure. It also allows us to reasonably rule out dysfunction of the right ventricle in cases of normality in these patients.
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Affiliation(s)
| | | | | | | | | | - Marta Cobo-Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | | | - Yale Tung-Chen
- Servicio de Medicina Interna, Hospital Universitario La Paz. Departamento de Medicina, Facultad de Medicina, Universidad Alfonso X El Sabio. IdiPAZ, Madrid, Spain.
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Evaluación de las presiones de llenado y la sobrecarga de volumen en la insuficiencia cardiaca: una visión actualizada. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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4
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Assessment of filling pressures and fluid overload in heart failure: an updated perspective. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:47-57. [PMID: 35934293 DOI: 10.1016/j.rec.2022.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/19/2022] [Indexed: 12/24/2022]
Abstract
Congestion plays a major role in the pathogenesis, presentation, and prognosis of heart failure and is an important therapeutic target. However, its severity and organ and compartment distribution vary widely among patients, illustrating the complexity of this phenomenon. Although clinical symptoms and signs are useful to assess congestion and manage volume status in individual patients, they have limited sensitivity and do not allow identification of congestion phenotype. This leads to diagnostic uncertainty and hampers therapeutic decision-making. The present article provides an updated overview of circulating biomarkers, imaging modalities (ie, cardiac and extracardiac ultrasound), and invasive techniques that might help clinicians to identify different congestion profiles and guide the management strategy in this diverse population of high-risk patients with heart failure.
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Herrmann EJ, Raghavan B, Eissing N, Fichtlscherer S, Hamm CW, Assmus B. Pulmonary Artery Pressure-Guided Telemonitoring Reduced Pulmonary Artery Pressure but Did Not Result in Higher Doses of Guideline-Directed Medical Therapy-Observations from an Advanced Elderly German Heart Failure Cohort. Life (Basel) 2022; 12:life12050766. [PMID: 35629432 PMCID: PMC9147310 DOI: 10.3390/life12050766] [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: 04/11/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Remote pulmonary artery pressure (PAP)-guided heart failure (HF) therapy for NYHA class III patients has been shown to reduce hospitalizations and increase survival. We aimed to assess whether PAP monitoring allows for the increase in HF directed medication in an elderly German cohort of advanced HF patients already receiving clinically optimized HF medication. Methods: We analyzed PAP and HF medication dosage, including diuretics, in 24 patients (mean age, 76 years) using implanted PAP-sensors during the first 12 months of PAP-guided HF care in an interdisciplinary HF unit. Results: During 12 months of PAP-guided HF therapy, PAP decreased significantly (△PAP systolic−6 ± 10, △PAP diastolic−4 ± 7, △PAP mean−4 ± 8 mm Hg, p < 0.01 for all). 16% of patients had an unplanned HF hospitalization. There was no significant change over time with respect to the dosage of RAAS inhibitors (ACE-I/ARB/ARNI), Beta blockers, or MRA treatments. In contrast, the dosage of loop diuretics increased significantly (2.1 ± 0.5-fold) over time. In the comparison of a “responder” (patients with PAP and diuretic dose decline) and “non-responder” (patients with PAP and diuretic dose increase) group, there were no significant differences between any of the baseline, medication, or HF hospitalization characteristics between the two groups. Conclusions: In elderly patients treated with clinically optimized HF medication, no further evidence-based medication increase could be achieved using PAP-guided HF care. However, by individual adjustment of diuretic dosage, a significant decline in PAP over time occurred, which could not be predicted by any of the baseline characteristics.
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Affiliation(s)
- Ester J. Herrmann
- Department of Medicine I, Cardiology, University Hospital Giessen and Marburg, 35392 Giessen, Germany; (E.J.H.); (B.R.); (C.W.H.)
| | - Badrinarayanan Raghavan
- Department of Medicine I, Cardiology, University Hospital Giessen and Marburg, 35392 Giessen, Germany; (E.J.H.); (B.R.); (C.W.H.)
| | - Nina Eissing
- Department of Medicine III, Cardiology, University Hospital Frankfurt am Main, 60590 Frankfurt am Main, Germany; (N.E.); (S.F.)
| | - Stephan Fichtlscherer
- Department of Medicine III, Cardiology, University Hospital Frankfurt am Main, 60590 Frankfurt am Main, Germany; (N.E.); (S.F.)
- German Center for Cardiovascular Research, DZHK, 10115 Berlin, Germany
| | - Christian W. Hamm
- Department of Medicine I, Cardiology, University Hospital Giessen and Marburg, 35392 Giessen, Germany; (E.J.H.); (B.R.); (C.W.H.)
- German Center for Cardiovascular Research, DZHK, 10115 Berlin, Germany
| | - Birgit Assmus
- Department of Medicine I, Cardiology, University Hospital Giessen and Marburg, 35392 Giessen, Germany; (E.J.H.); (B.R.); (C.W.H.)
- Department of Medicine III, Cardiology, University Hospital Frankfurt am Main, 60590 Frankfurt am Main, Germany; (N.E.); (S.F.)
- German Center for Cardiovascular Research, DZHK, 10115 Berlin, Germany
- Correspondence:
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Hammadah M, Ponce C, Sorajja P, Cavalcante JL, Garcia S, Gössl M. Point-of-care ultrasound: Closing guideline gaps in screening for valvular heart disease. Clin Cardiol 2020; 43:1368-1375. [PMID: 33174635 PMCID: PMC7724242 DOI: 10.1002/clc.23499] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A linear increase in the number of valvular heart disease is expected due to the aging population, yet most patients with severe valvular heart disease remain undiagnosed. HYPOTHESIS POCUS can serve as a screening tool for valvular heart disease. METHODS We reviewed the literature to assess the strengths and limitations of POCUS in screening and diagnosing valvular heart disease. RESULTS POCUS is an accurate, affordable, accessible, and comprehensive tool. It has a fast learning curve and can prevent unnecessary and more expensive imaging. Challenges include training availability, lack of simplified screening protocols, and reimbursement. Large scale valvular screening data utilizing POCUS is not available. CONCLUSION POCUS can serve as a screening tool and guide the management of patients with valvular heart disease. More data is needed about its efficacy and cost-effectiveness in the screening of patients with valvular heart disease.
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Affiliation(s)
- Muhammad Hammadah
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Christopher Ponce
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Paul Sorajja
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - João L. Cavalcante
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Santiago Garcia
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Mario Gössl
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
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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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Farahmand S, Abdolhoseini A, Aliniagerdroudbari E, Babaniamansour S, Baratloo A, Bagheri-Hariri S. Point-of-care ultrasound modalities in terms of diagnosing acute decompensated heart failure in emergency department; a diagnostic accuracy study. Intern Emerg Med 2020; 15:491-499. [PMID: 31786750 DOI: 10.1007/s11739-019-02233-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/08/2019] [Indexed: 11/27/2022]
Abstract
This study aimed to compare the diagnostic accuracy of heart, lung and inferior vena cava (IVC) ultrasonography modalities, alone and combined, for possible added accuracy in diagnosing acute decompensated heart failure (ADHF), in a group of patients with the final diagnosis of ADHF based on plasma level of B-type natriuretic peptide (BNP) as the standard. The present study is a diagnostic accuracy study, which was carried out in the emergency department of Imam Khomeini hospital, affiliated to Tehran University of Medical Sciences, in 2014-2015. All patients over 18 years old, who were referred to emergency department with complaint of acute dyspnea were regarded as eligible and no exclusion criteria were considered. All ultrasounds were performed by a trained emergency medicine resident and then saved and classified for each patient, separately, and reviewed by the attending emergency medicine physician. In this study, patients with BNP levels higher than 500 pg/ml were considered positive for dyspnea caused by heart failure. A total of 120 patients with an average age of 60.83 ± 16.528 years were studied, 64 (53%) of which were male. In total, 47.5% of patients had a BNP level over 500 pg/ml. Among patients with positive ultrasound, 94.7% were true positive and among those with a negative ultrasound, 61.4% were true negative. Based on the findings, B-line ≥ 10 has the highest specificity and left ventricular ejection fraction (LVEF) < 45% has the highest sensitivity. The combination of LVEF and IVC collapsibility index (IVC-CI), LVEF and BLC, IVC-CI and BLC, and IVC-CI and BBPC had a higher specificity rate and combination of LVEF and BBPC and BLC and BBPC had the highest sensitivity. Sensitivity, specificity, positive predictive value and negative predictive value of all three ultrasounds combined were 31.6%, 98.4%, 94.7% and 61.4%, respectively. In this study, the diagnostic accuracy of double and triple ultrasonography of heart, lung and IVC in the diagnosis of ADHF was very high, among which triple ultrasonography was more preferable.
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Affiliation(s)
- Shervin Farahmand
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Abdolhoseini
- Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Alireza Baratloo
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Bagheri-Hariri
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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Spencer KT, Flachskampf FA. Focused Cardiac Ultrasonography. JACC Cardiovasc Imaging 2019; 12:1243-1253. [DOI: 10.1016/j.jcmg.2018.12.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 11/30/2022]
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10
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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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Pourmand A, Pyle M, Yamane D, Sumon K, Frasure SE. The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients. World J Emerg Med 2019; 10:232-238. [PMID: 31534598 DOI: 10.5847/wjem.j.1920-8642.2019.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Volume resuscitation has only been demonstrated to be effective in approximately fifty percent of patients. The remaining patients do not respond to volume resuscitation and may even develop adverse outcomes (such as acute pulmonary edema necessitating endotracheal intubation). We believe that point-of-care ultrasound is an excellent modality by which to adequately predict which patients may benefit from volume resuscitation. DATA RESOURCES We performed a search using PubMed, Scopus, and MEDLINE. The following search terms were used: fluid responsiveness, ultrasound, non-invasive, hemodynamic, fluid challenge, and passive leg raise. Preference was given to clinical trials and review articles that were most relevant to the topic of assessing a patient's cardiovascular ability to respond to intravenous fluid administration using ultrasound. RESULTS Point-of-care ultrasound can be easily employed to measure the diameter and collapsibility of various large vessels including the inferior vena cava, common carotid artery, subclavian vein, internal jugular vein, and femoral vein. Such parameters are closely related to dynamic measures of fluid responsiveness and can be used by providers to help guide fluid resuscitation in critically ill patients. CONCLUSION Ultrasound in combination with passive leg raise is a non-invasive, cost- and time-effective modality that can be employed to assess volume status and response to fluid resuscitation. Traditionally sonographic studies have focused on the evaluation of large veins such as the inferior vena cava, and internal jugular vein. A number of recently published studies also demonstrate the usefulness of evaluating large arteries to predict volume status.
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Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Matthew Pyle
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - David Yamane
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kazi Sumon
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sarah E Frasure
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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12
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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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