Noninvasive estimation of intravascular volume status in cirrhosis by dynamic size and collapsibility indices of the inferior vena cava using bedside echocardiography
| Autor: | Jelen S Khumuckham, Kamal Kajal, Devaraja Rangegowda, Madhumita Premkumar |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Cirrhosis Portal venous pressure RC799-869 Inferior vena cava 03 medical and health sciences 0302 clinical medicine Internal medicine medicine.artery Ascites medicine Intravascular volume status echocardiography Pulmonary wedge pressure inferior vena cava collapsibility Hepatology business.industry central venous pressure Gastroenterology Central venous pressure Original Articles Diseases of the digestive system. Gastroenterology medicine.disease intravascular volume status medicine.vein 030220 oncology & carcinogenesis Pulmonary artery cirrhotic cardiomyopathy Cardiology Original Article 030211 gastroenterology & hepatology medicine.symptom inferior vena cava business |
| Zdroj: | JGH Open: An Open Access Journal of Gastroenterology and Hepatology JGH Open, Vol 3, Iss 4, Pp 322-328 (2019) |
| ISSN: | 2397-9070 |
| DOI: | 10.1002/jgh3.12166 |
| Popis: | Background and aim Echocardiographic assessment of the inferior vena cava diameter (IVCD) and collapsibility index (IVCCI) is a noninvasive estimate of intravascular volume status (IVS) but requires validation for cirrhosis. We evaluated IVC dynamics in cirrhosis and correlated it with conventional tools such as central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and right atrial pressure (RAP). Methods A total of 673 consecutive cirrhotic patients were screened by echocardiography, and 125 patients underwent right heart catheterization with recording of hepatic venous pressure gradient (HVPG), RAP, pulmonary artery (PA) pressure, and PCWP. CVP data were available for 80 (64%) patients, and finally, 76 patients (84% male, 50% ethanol related, mean age 52.1 years, 57.8% with ascites) with complete data were enrolled. Results The mean CVP measured was 12.8 ± 4.8 mmHg, and IVCCI was 29.5 ± 10.9%. The IVCD ranged from 0.97 to 2.26 cm and from 0.76 to 1.84 cm during expiration and inspiration, respectively, with a mean of 1.8 ± 0.9 cm. The mean IVCD correlated with RAP (r = 0.633, P = 0.043) but not with HVPG (r = 0.344, P = 0.755), PCWP (r = 0.562, P = 0.072), or PA pressure (r = 0.563, P = 0.588). A negative linear correlation was observed between the CVP and the IVCCI (r = -0.827, P = 0.023) in all patients and substratified for those with (r = -0.748, P = 0.039) and without ascites (r = -0.761, P = 0.047). A positive correlation was observed between CVP and IVCDmax (r = 0.671, P = 0.037) and IVCDmin (r = 0.612, P = 0.040). Conclusions IVCD and collapsibility index provides noninvasive IVS assessment, independent of HVPG or ascites, with the potential for calculating fluid requirements in cirrhosis. |
| Databáze: | OpenAIRE |
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