Estimation of Central Venous Pressure Using the Ratio of Short to Long Diameter from Cross-Sectional Images of the Inferior Vena Cava

Yoshihiro Seo; Noriko Iida; Masayoshi Yamamoto; Tomoko Machino-Ohtsuka; Tomoko Ishizu; Kazutaka Aonuma

doi:10.1016/j.echo.2016.12.002

Estimation of Central Venous Pressure Using the Ratio of Short to Long Diameter from Cross-Sectional Images of the Inferior Vena Cava

J Am Soc Echocardiogr. 2017 May;30(5):461-467. doi: 10.1016/j.echo.2016.12.002. Epub 2017 Jan 5.

Authors

Yoshihiro Seo¹, Noriko Iida², Masayoshi Yamamoto³, Tomoko Machino-Ohtsuka³, Tomoko Ishizu³, Kazutaka Aonuma³

Affiliations

¹ Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: yo-seo@md.tsukuba.ac.jp.
² Clinical Laboratory, University of Tsukuba Hospital, Tsukuba, Japan.
³ Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

PMID: 28065586
DOI: 10.1016/j.echo.2016.12.002

Abstract

Background: Long-axis images of the inferior vena cava (IVC) have limitations as surrogates for IVC morphology in grading central venous pressure (CVP) by two-dimensional echocardiography (2DE), because of the various cross-sectional morphologies and the translational motion of the IVC induced by sniffing. On the basis of the relationship between venous pressure and compliance, it was hypothesized that the cross-sectional morphology of the IVC, which was obtained using three-dimensional echocardiography, might estimate CVP more accurately compared with standard grading by 2DE.

Methods: Sixty consecutive patients who underwent right-heart catheterization studies were prospectively enrolled. Echocardiography was performed <24 hours before catheterization. From three-dimensional data sets, a cross-section of the IVC was determined that was perpendicular to the long-axis reference of the IVC. Short diameter (SD), long diameter (LD), the ratio of SD to LD (S/L) as the sphericity index, and area were measured on this cross-sectional IVC image.

Results: CVP correlated moderately with SD (r = 0.69, P < .001), strongly with S/L (r = 0.75, P < .001), and modestly with area (r = 0.47, P < .001) but not with LD (r = 0.24, P = .17). The largest areas under the curve by receiver operating characteristic analyses to detect CVP ≥ 10 mm Hg were 0.98 (95% CI, 0.97-1.0; P < .001) for S/L, 0.83 for SD (95% CI, 0.74-0.94; P < .001), and 0.70 for area (95% CI, 0.56-0.84; P = .02). If a cutoff value of 0.69 for S/L was used, the sensitivity, specificity, and accuracy to detect CVP ≥ 10 mm Hg were 0.94, 0.95, and 0.95 and for CVP grading by 2DE were 0.59, 0.98, and 0.85, respectively. Estimations of CVP were more accurately reclassified using S/L rather than grading by 2DE (net reclassification improvement, 0.38; 95% CI, 0.31-0.44; P < .001).

Conclusions: S/L of an IVC cross-section measured using three-dimensional echocardiography may be a reliable parameter to estimate CVP compared with standard grading by 2DE.

Keywords: Central venous pressure; Heart failure; Inferior vena cava; Three-dimensional echocardiography.

MeSH terms

Algorithms
Blood Pressure Determination / methods*
Central Venous Pressure*
Female
Heart Failure / diagnostic imaging*
Heart Failure / physiopathology*
Humans
Image Interpretation, Computer-Assisted / methods*
Imaging, Three-Dimensional / methods
Male
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Vena Cava, Inferior / diagnostic imaging*
Vena Cava, Inferior / physiopathology*