Changes in the Inferior Vena Cava Are More Sensitive Than Venous Pressure During Fluid Removal: A Proof-of-Concept Study

Background: Congestion is central to the pathophysiology of heart failure (HF); thus, tracking congestion is crucial for the management of patients with HF. In this study we aimed to com-pare changes in inferior vena cava diameter (IVCD) with venous pressure following manipula-tion of volume status during ultrafiltration in patients with cardiac dysfunction.Methods and Results: Patients with stable hemodialysis and with systolic or diastolic dysfunc-tion were studied. Central venous pressure (CVP) and peripheral venous pressure (PVP) were measured before and after hemodialysis. IVCD and PVP were measured simultaneously just before dialysis, 3 times during dialysis and immediately after dialysis. Changes in IVCD and PVP were compared at each timepoint with ultrafiltration volumes. We analyzed 30 hemodi-alysis sessions from 20 patients. PVP was validated as a surrogate for CVP. Mean ultrafiltration volume was 2102 +/- 667 mL. IVCD discriminated better ultrafiltration volumes < 500 mL or < 750 mL than PVP (AUC 0.80 vs 0.62, and 0.80 vs 0.56, respectively; both P< 0.01). IVCD appeared to track better ultrafiltration volume (P< 0.01) and hemoconcentration (P< 0.05) than PVP. Changes in IVCD were of greater magnitude than those of PVP (average change from predialysis:-58 +/- 30% vs-28 +/- 21%; P< 0.001).Conclusions: In patients undergoing ultrafiltration, changes in IVCD tracked changes in volume status better than venous pressure. (J Cardiac Fail 2023;29:463-472)

Automated summary

In this study, we compared changes in inferior vena cava diameter (IVCD) with venous pressure during ultrafiltration in patients with cardiac dysfunction. The results showed that IVCD tracked changes in volume status and hemoconcentration better than venous pressure, suggesting that IVCD is a more accurate indicator for monitoring the management of heart failure patients.