title: Prognostic significance of dilated inferior vena cava in advanced decompensated heart failure.
abstract: Dilated inferior vena cava (IVC) is prevalent among patients with heart failure (HF), but whether its presence predicts worsening renal function (WRF) or adverse outcomes is unclear. This cohort study analyzed patients with left ventricular ejection fraction <40 % and repeated hospitalizations (≥2 times) for HF between August 2009 and August 2011. The study endpoints were death and HF re-hospitalization. Among baseline parameters, IVC diameter was the most powerful predictor for the development of WRF (area under the curve = 0.795, cut-off value = 20.5 mm). During the 2-year follow-up, 36 patients (49 %) were re-hospitalized for HF and 14 patients (19 %) died. The event rates were significantly greater in the WRF group than in the non-WRF group (71 vs. 30 %, P < 0.001 for HF re-hospitalization; 29 vs. 10 %, P = 0.03 for death). In Cox regression model, the risk of combined end-points was increased in patients with aging, elevated blood urine nitrogen, IVC >21 mm, and WRF. When adjusted for confounding factors, IVC >21 mm [hazard ratio (HR) 3.73, 95 % confidence interval (CI) 1.66-8.34] and WRF (HR 2.68, 95 % CI 1.07-6.75) were significant predictors for adverse outcomes. In patients with advanced decompensated HF, dilated IVC (>21 mm) predicted the development of WRF and could be a predictor for adverse outcomes.
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
authors.forename: Hsin-Fu
authors.initials: HF
authors.lastname: Lee
authors.forename: Lung-An
authors.initials: LA
authors.lastname: Hsu
authors.forename: Chi-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Yi-Hsin
authors.initials: YH
authors.lastname: Chan
authors.forename: Chun-Li
authors.initials: CL
authors.lastname: Wang
authors.forename: Wan-Jing
authors.initials: WJ
authors.lastname: Ho
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001806:Blood Urea Nitrogen; D059347:Cardio-Renal Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D004108:Dilatation, Pathologic; D018450:Disease Progression; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left