Among ambulatory patients with chronic heart failure, a dilated inferior vena cava with normal tricuspid regurgitation velocity was associated with a significantly higher risk of mortality (HR 2.51) compared to patients with normal IVC and TRV.
Cohort (n=895)
No
Is a dilated inferior vena cava or an elevated tricuspid regurgitation velocity more strongly associated with mortality in patients with chronic heart failure?
In ambulatory patients with chronic heart failure, systemic venous congestion reflected by a dilated inferior vena cava is a stronger predictor of adverse prognosis than pulmonary hypertension indicated by an elevated tricuspid regurgitation velocity.
Effect estimate: HR 2.51 (95% CI 1.80-3.51)
p-value: p=<0.001
AIMS: A high, Doppler-derived, tricuspid regurgitation velocity (TRV) indicates pulmonary hypertension, which may contribute to right ventricular dysfunction and worsening tricuspid regurgitation leading to systemic venous congestion, reflected by an increase in inferior vena cava (IVC) diameter. We hypothesized that venous congestion rather than pulmonary hypertension would be more strongly associated with prognosis. METHODS AND RESULTS: 895 patients with chronic heart failure (CHF) (median (25th and 75th centile) age 75 (67-81) years, 69% men, LVEF 44 (34-55)% and NT-proBNP 1133 (423-2465) pg/ml) were enrolled. Compared to patients with normal IVC (< 21 mm) and TRV (≤ 2.8 m/s; n = 504, 56%), those with high TRV but normal IVC (n = 85, 9%) were older, more likely to be women and to have LVEF ≥ 50%, whilst those with dilated IVC but normal TRV (n = 142, 16%) had more signs of congestion and higher NT-proBNP. Patients (n = 164, 19%) with both dilated IVC and high TRV had the most signs of congestion and the highest NT-proBNP. During follow-up of 860 (435-1121) days, 239 patients died. Compared to those with both normal IVC and TRV (reference), patients with high TRV but normal IVC did not have a significantly increased mortality (HR: 1.41; CI: 0.87-2.29; P = 0.16). Risk was higher for patients with a dilated IVC but normal TRV (HR: 2.51; CI: 1.80-3.51; P < 0.001) or both a dilated IVC and elevated TRV (HR: 3.27; CI: 2.40-4.46; P < 0.001). CONCLUSION: Amongst ambulatory patients with CHF, a dilated IVC is more closely associated with an adverse prognosis than an elevated TRV.
Iaconelli et al. (Fri,) conducted a cohort in Chronic heart failure (n=895). Dilated inferior vena cava (≥ 21 mm) with normal tricuspid regurgitation velocity vs. Normal inferior vena cava (< 21 mm) and normal tricuspid regurgitation velocity (≤ 2.8 m/s) was evaluated on All-cause mortality (HR 2.51, 95% CI 1.80-3.51, p=<0.001). Among ambulatory patients with chronic heart failure, a dilated inferior vena cava with normal tricuspid regurgitation velocity was associated with a significantly higher risk of mortality (HR 2.51) compared to patients with normal IVC and TRV.