Usefulness of Serial Measurements of Inferior Vena Cava Diameter by VscanTM to Identify Patients With Heart Failure at High Risk of Hospitalization

Raj M. Khandwalla, Kade T. Birkeland, Raymond Zimmer, Timothy D Henry, Roland Nazarian, Madhuri Sudan, James Mirocha, Jeena Cha, Ilan Kedan

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Estimation of volume status is integral to heart failure (HF) management. Measurement of inferior vena cava (IVC) diameter (IVCd) by ultrasound provides a noninvasive estimate of right atrial pressures. The GE Vscan is a handheld ultrasound (HHU) device that allows for point-of-care measurements to assess volume status. We hypothesize that IVCd measurements using HHU can predict the risk of HF admission. We retrospectively analyzed a cohort of patients with HF treated in an ambulatory care setting over 17 months. Serial measurements of IVCd were obtained using HHU in the supine position from the subcostal window. Log-binomial regression models were used to compare IVCd measurements between patients with and without HF admissions and to estimate the association between IVCd and risk of HF admission. Of the 355 patients with systolic (38%) and diastolic HF (62%) who were analyzed, 45% were women with a mean age of 73 years at the time of the first IVCd measurement. Overall, 3,488 measurements were obtained, and 32.4% of patients were hospitalized during follow-up. Patients with at least 1 hospital admission had a greater mean IVCd than those who were not admitted (2.0 vs 1.8 cm, p <0.01). In our analysis, every 0.5-cm increase in the mean IVCd was associated with a 38% increase in risk of HF admission (risk ratio [RR] 1.38, 95% CI 1.16 to 1.62, p <0.01). The risk of HF admission was also significantly increased in patients with IVCd 2.0 to 2.49 cm (RR 1.79, 95% CI 1.27 to 2.52, p <0.01) and ≥2.5 cm (RR 2.39, 95% CI 1.55 to 3.67, p <0.01), compared with patients with an IVCd < 2.0 cm. Increasing IVCd as measured by HHU at the point-of-care is associated with an increased risk of HF admission and may provide clinically useful information at the point-of-care to guide HF management.

Original languageEnglish (US)
Pages (from-to)1631-1636
Number of pages6
JournalAmerican Journal of Cardiology
Volume119
Issue number10
DOIs
StatePublished - May 15 2017

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Inferior Vena Cava
Hospitalization
Heart Failure
Point-of-Care Systems
Odds Ratio
Diastolic Heart Failure
Systolic Heart Failure
Atrial Pressure
Supine Position
Statistical Models
Ambulatory Care
Equipment and Supplies

Cite this

Usefulness of Serial Measurements of Inferior Vena Cava Diameter by VscanTM to Identify Patients With Heart Failure at High Risk of Hospitalization. / Khandwalla, Raj M.; Birkeland, Kade T.; Zimmer, Raymond; Henry, Timothy D; Nazarian, Roland; Sudan, Madhuri; Mirocha, James; Cha, Jeena; Kedan, Ilan.

In: American Journal of Cardiology, Vol. 119, No. 10, 15.05.2017, p. 1631-1636.

Research output: Contribution to journalArticle

Khandwalla, RM, Birkeland, KT, Zimmer, R, Henry, TD, Nazarian, R, Sudan, M, Mirocha, J, Cha, J & Kedan, I 2017, 'Usefulness of Serial Measurements of Inferior Vena Cava Diameter by VscanTM to Identify Patients With Heart Failure at High Risk of Hospitalization', American Journal of Cardiology, vol. 119, no. 10, pp. 1631-1636. https://doi.org/10.1016/j.amjcard.2017.02.007
Khandwalla, Raj M. ; Birkeland, Kade T. ; Zimmer, Raymond ; Henry, Timothy D ; Nazarian, Roland ; Sudan, Madhuri ; Mirocha, James ; Cha, Jeena ; Kedan, Ilan. / Usefulness of Serial Measurements of Inferior Vena Cava Diameter by VscanTM to Identify Patients With Heart Failure at High Risk of Hospitalization. In: American Journal of Cardiology. 2017 ; Vol. 119, No. 10. pp. 1631-1636.
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abstract = "Estimation of volume status is integral to heart failure (HF) management. Measurement of inferior vena cava (IVC) diameter (IVCd) by ultrasound provides a noninvasive estimate of right atrial pressures. The GE Vscan is a handheld ultrasound (HHU) device that allows for point-of-care measurements to assess volume status. We hypothesize that IVCd measurements using HHU can predict the risk of HF admission. We retrospectively analyzed a cohort of patients with HF treated in an ambulatory care setting over 17 months. Serial measurements of IVCd were obtained using HHU in the supine position from the subcostal window. Log-binomial regression models were used to compare IVCd measurements between patients with and without HF admissions and to estimate the association between IVCd and risk of HF admission. Of the 355 patients with systolic (38{\%}) and diastolic HF (62{\%}) who were analyzed, 45{\%} were women with a mean age of 73 years at the time of the first IVCd measurement. Overall, 3,488 measurements were obtained, and 32.4{\%} of patients were hospitalized during follow-up. Patients with at least 1 hospital admission had a greater mean IVCd than those who were not admitted (2.0 vs 1.8 cm, p <0.01). In our analysis, every 0.5-cm increase in the mean IVCd was associated with a 38{\%} increase in risk of HF admission (risk ratio [RR] 1.38, 95{\%} CI 1.16 to 1.62, p <0.01). The risk of HF admission was also significantly increased in patients with IVCd 2.0 to 2.49 cm (RR 1.79, 95{\%} CI 1.27 to 2.52, p <0.01) and ≥2.5 cm (RR 2.39, 95{\%} CI 1.55 to 3.67, p <0.01), compared with patients with an IVCd < 2.0 cm. Increasing IVCd as measured by HHU at the point-of-care is associated with an increased risk of HF admission and may provide clinically useful information at the point-of-care to guide HF management.",
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AU - Birkeland, Kade T.

AU - Zimmer, Raymond

AU - Henry, Timothy D

AU - Nazarian, Roland

AU - Sudan, Madhuri

AU - Mirocha, James

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