Inferior vena cava collapsibility index, renal dysfunction, and adverse outcomes in patients with broad spectrum cardiovascular disease

Echocardiography. 2017 Jan;34(1):20-28. doi: 10.1111/echo.13409. Epub 2016 Nov 3.

Abstract

Aims: The clinical implication of the inferior vena cava collapsibility index (IVCCI) has not been well evaluated in patients with various cardiovascular diseases.

Method and results: The relationships between clinical characteristics and echocardiographic indicators of the systemic intravascular volume status [IVCCI; the ratio of the early transmitral and early myocardial diastolic velocities (E/Em)] were evaluated at baseline, and the clinical status during follow-up was compared across the IVCCI levels. Among 1166 patients (mean age=63.8±13.4 years), 934, 171, and 61 had high (≥50%), intermediate (25%-50%), and low (<25%) IVCCIs, respectively. Age-, sex-, and body mass index-adjusted serum creatinine (sCr) levels were highest in patients with low IVCCI (P=.002) and E/Em >15 (P<.001). During follow-up (1108±463 days), 67 patients died, and 38 of these deaths were cardiovascular related. Age, body mass index, heart failure (HF), sCr levels, and a low IVCCI (vs high IVCCI: hazard ratio [HR]=3.193, 95% confidence interval [CI]=1.297-7.857, P=.012) were associated with all-cause mortality in multivariable analysis. HF, diuretic use, and a low IVCCI (vs high IVCCI: HR=4.428, 95% CI=1.406-13.104, P=.007) were significantly associated with cardiovascular mortality.

Conclusion: A low IVCCI was significantly associated with reduced renal function and was an independent risk factor for adverse outcomes, regardless of underlying cardiovascular disease and renal function.

Keywords: cardiovascular death; heart failure; inferior vena cava; renal function.

MeSH terms

  • Aged
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / mortality
  • Cause of Death / trends
  • Central Venous Pressure / physiology*
  • Echocardiography / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Renal Insufficiency / etiology
  • Renal Insufficiency / physiopathology*
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Vena Cava, Inferior / diagnostic imaging*
  • Vena Cava, Inferior / physiopathology*