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Inferior vena cava diameter in acute decompensated heart failure as predictor of all-cause mortality

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Abstract

Inferior vena cava (IVC) diameter can be used to approximate right atrial pressure in patients admitted for acute decompensated heart failure (ADHF). Recent studies linked IVC dilation to an increased risk of early re-admission and short-term mortality. Moreover, renal insufficiency (RI) is an established risk factor for mortality in ADHF and is associated with congestion. We hypothesized that the IVC diameter is a marker of all-cause mortality but its prognostic impact may be influenced by kidney function. We analyzed data of 1101 patients admitted for ADHF with available echocardiography of the IVC by chart review and death registry linkage. Patients were dichotomized according to a cut-off value of 21 mm. Cox proportional hazards model was used to identify mortality predictors. A dilated IVC was detected in 474 (43.1%) patients. Overall, 400 (36.3%) patients died within 3 years. All-cause mortality was significantly higher in patients with dilated IVC [hazard ratio 1.45 (confidence interval 1.21–1.74); p < 0.001]. However, a dilated IVC was only associated with all-cause mortality in patients with RI function [hazard ratio 1.60 (confidence interval 1.26–2.03); p < 0.001] but not in patients with a preserved kidney function [hazard ratio 1.04 (confidence interval 0.72–1.50); P = 0.84]. IVC diameter was identified as an independent predictor for all-cause mortality in a Cox proportional hazards model with a significant interaction between IVC diameter and baseline kidney function. In conclusion, IVC dilation is a marker of high mortality risk in patients admitted for ADHF. However, this observation was confined to patients with RI.

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Abbreviations

ADHF:

Acute decompensated heart failure

CI:

Confidence interval

eGFR:

Estimated glomerular filtration rate

HFrEF:

Heart failure with reduced ejection fraction

HR:

Hazard ratio

IVC:

Inferior vena cava

IVCCI:

IVC collapsibility index

IVCmax:

Maximum IVC diameter

IVCmin:

Minimum IVC diameter

RI:

Renal insufficiency

WRF:

Worsening renal function

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Authors and Affiliations

  1. Department of Cardiology, Angiology and Intensive Care Medicine, Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Alexander Jobs, Kerstin Brünjes, Steffen Desch, Michael Reppel & Holger Thiele

  2. German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany

    Alexander Jobs, Steffen Desch & Holger Thiele

  3. Insitute for Cancer Epidemiology e.V., University of Lübeck, Lübeck, Germany

    Alexander Katalinic & Valentin Babaev

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  1. Alexander Jobs
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  2. Kerstin Brünjes
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Correspondence to Alexander Jobs.

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Jobs, A., Brünjes, K., Katalinic, A. et al. Inferior vena cava diameter in acute decompensated heart failure as predictor of all-cause mortality. Heart Vessels 32, 856–864 (2017). https://doi.org/10.1007/s00380-017-0944-0

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