Right heart failure: diagnosis via ultrasonography of the inferior vena cava and hepatic veins

PURPOSE: To determine the efficiency of ultrasonographic measurements of the inferior vena cava (IVC) and hepatic vein (HV) in the detection of elevated systemic venous pressure due to right heart failure.

MATERIAL AND METHODS: Measurements of the Collapsibility Index (CI) of the Inferior vena cava (IVC) and hepatic vein (HV) was obtained from 95 persons without right failure. The CI values of 32 patients with clinically documented right heart failure and the data of a subgroup of 24 patients who received therapy, were statistically compared to those of the group without right heart failure.

RESULTS: There were statistical significant differences between the CI of the persons without and the patients with right heart failure and between the patients before and after therapy (two-sample T-test: p < 0.05). The position of the ROC curve indicates that measurements of the CI of the IVC and HV enables to distinguish very well patients with right heart failure from those without right heart failure. If the cut-off CI value between normal and abnormal of the IVC was set at 0.22, the sensitivity was 78% and the specificity 98%. When the cut-off value of the CI of the HV was set at 0.25 the sensitivity was 78% and the specificity 96%. There was good interobserver agreement with regard to the CI values of the IVC (correlation coefficient 0.65), but poor interobserver agreement with regard to the CI values of the HV (correlation coefficient 0.35).

CONCLUSION: Ultrasonographic measurement of the CI of the inferior vena cava is particularly useful to exclude systemic venous congestion in right heart failure and to monitor the effect of therapy.