title: The utility of inferior vena cava diameter and the degree of inspiratory collapse in patients with systolic heart failure.
abstract: BACKGROUND
  Both inferior vena cava (IVC) diameter and the degree of inspiratory collapse are used in the estimation of right atrial pressure.
  
  
  OBJECTIVE
  The purpose of this study is to evaluate the utility of IVC diameter, using echocardiography as a marker of volume overload and the relationship between these parameters and N-terminal pro-B natriuretic peptide (NT-proBNP) in patients with systolic heart failure (HF).
  
  
  METHODS
  We included 136 consecutive patients with systolic HF (left ventricular ejection fraction, <50%), including 80 patients with acutely decompensated HF and 56 patients with compensated HF as well as 50 subjects without a diagnosis of HF. All patients underwent transthoracic echocardiography to assess both their IVC diameters and the degree of inspiratory collapse (≥50%, <50%, and no change [absence] groups); NT-proBNP levels were measured, and these data were compared between the 2 groups.
  
  
  RESULTS
  Inferior vena cava diameter and NT-proBNP were significantly higher among the patients with HF than among the control subjects (21.7 ± 2.6 vs 14.5 ± 1.6 mm, P < .001 and 4789 [330-35000] vs 171 [21-476], P < .001). The mean IVC diameter was higher among the patients with decompensated HF than among the patients with compensated HF (23.2 ± 2.1 vs 19.7 ± 1.9 mm, P < .001). The values of NT-proBNP were associated with different collapsibility of IVC subgroups among HF patients. The NT-proBNP levels were 2760 (330-27336), 5400 (665-27210), and 16806 (1786-35000), regarding the collapsibility of the IVC subgroups: greater than or equal to 50%, less than 50%, and absence groups, P < .001, respectively, among HF patients. There was a significant positive correlation between IVC diameter and NT-proBNP (r = 0.884, P < .001). A cut off value of an IVC diameter greater than or equal to 20.5 mm predicted a diagnosis of compensated HF with a sensitivity of 90% and a specificity of 73%.
  
  
  CONCLUSIONS
  Inferior vena cava diameter correlated significantly with NT-proBNP in patients with HF. Inferior vena cava diameter may be a useful variable in determining a patient's volume status in the setting of HF and may also enable clinicians to distinguish patients with decompensated HF from those with compensated HF.
authors.affiliation: Department of Cardiology, Duzce Ataturk State Hospital, Duzce, Turkey. Electronic address: feyzullahbesli@gmail.com.
authors.forename: Feyzullah
authors.initials: F
authors.lastname: Besli
authors.affiliation: Department of Cardiology, Karacabey State Hospital, Karacabey, Bursa, Turkey.
authors.forename: Mesut
authors.initials: M
authors.lastname: Kecebas
authors.affiliation: Department of Cardiology, Uludag University School of Medicine Hospital, Bursa, Turkey.
authors.forename: Serhat
authors.initials: S
authors.lastname: Caliskan
authors.affiliation: Department of Cardiology, Uludag University School of Medicine Hospital, Bursa, Turkey.
authors.forename: Seckin
authors.initials: S
authors.lastname: Dereli
authors.affiliation: Department of Cardiology, Uludag University School of Medicine Hospital, Bursa, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Baran
authors.affiliation: Department of Cardiology, Duzce University School of Medicine Hospital, Duzce, Turkey.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Turker
mesh_terms: D015415:Biomarkers / Q000097:blood; D004452:Echocardiography; D005260:Female; D054143:Heart Failure, Systolic / Q000097:blood* / Q000000981:diagnostic imaging*; D006801:Humans; D001239:Inhalation; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D012680:Sensitivity and Specificity; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain