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?

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.