Noninvasive estimation of intravascular volume status in cirrhosis by dynamic size and collapsibility indices of the inferior vena cava using bedside echocardiography

Madhumita Premkumar, Devaraja Rangegowda, Kamal Kajal, Jelen S Khumuckham, Madhumita Premkumar, Devaraja Rangegowda, Kamal Kajal, Jelen S Khumuckham

Abstract

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.

Keywords: central venous pressure; cirrhotic cardiomyopathy; echocardiography; inferior vena cava; inferior vena cava collapsibility; intravascular volume status.

Figures

Figure 1
Figure 1
(a) Correlation between central venous pressure and inferior vena cava collapsibility index in all subjects (n = 76). (b) Correlation between central venous pressure and inferior vena cava (IVC) collapsibility index in patients with ascites.
Figure 2
Figure 2
(a) Correlation between expiratory inferior vena cava (IVC) diameter and central venous pressure. (b) Correlation between inspiratory IVC diameter and central venous pressure.

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