Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, United Kingdom.
JACC Cardiovasc Imaging. 2013 Jan;6(1):16-28. doi: 10.1016/j.jcmg.2012.08.012.
The aim of this study was to assess the relation between inferior vena cava (IVC) diameter, clinical variables, and outcome in patients with chronic heart failure (HF).
The IVC distends as right atrial pressure rises. Therefore it might represent an index of HF severity independent of left ventricular ejection fraction (LVEF). The relation between IVC diameter and other clinical variables and its prognostic significance in patients with HF has not been explored.
Outpatients attending a community HF service between 2008 and 2010 were enrolled. Heart failure was defined as the presence of relevant symptoms and signs and objective evidence of cardiac dysfunction: either LVEF <45% or the combination of both left atrial dilation (≥4 cm) and raised amino-terminal pro-brain natriuretic peptide (NT-proBNP) ≥400 pg/ml. Patients were followed for a median of 567 (interquartile range: 413 to 736) days. The primary composite endpoint was cardiovascular death and HF hospitalization.
Among the 693 patients enrolled, median age was 73 years, 33% were women, and 568 had HF. Patients with HF in the highest tertile of IVC diameter were older; had lower body mass index; were more likely to have atrial fibrillation and to be treated with diuretics; and had larger left atrial volumes, higher pulmonary pressures, and less negative values for global longitudinal strain. The LVEF and systolic blood pressure were similar across tertiles of IVC diameter. The IVC diameter and log [NT-proBNP] were correlated (r = 0.55, p < 0.001). During follow-up, 158 patients reached a primary endpoint. In a multivariable Cox regression model, including NT-proBNP, only increasing IVC diameter, urea, and the trans-tricuspid systolic gradient independently predicted a poor outcome. Neither global longitudinal strain nor LVEF were adverse predictors.
In patients with chronic HF with or without a reduced LVEF, increasing IVC diameter identifies patients with an adverse outcome.
本研究旨在评估慢性心力衰竭（HF）患者下腔静脉（IVC）直径与临床变量和预后之间的关系。
当右心房压力升高时，IVC 会扩张。因此，它可能是一种独立于左心室射血分数（LVEF）的 HF 严重程度的指标。IVC 直径与其他临床变量之间的关系及其在 HF 患者中的预后意义尚未得到探索。
2008 年至 2010 年间，参加社区 HF 服务的门诊患者被纳入研究。心力衰竭的定义为存在相关症状和体征以及心脏功能障碍的客观证据：LVEF<45%或左心房扩张（≥4cm）和氨基末端脑利钠肽前体（NT-proBNP）升高（≥400pg/ml）的组合。患者的中位随访时间为 567（四分位距：413 至 736）天。主要复合终点为心血管死亡和 HF 住院。
在纳入的 693 名患者中，中位年龄为 73 岁，33%为女性，568 名患者患有 HF。IVC 直径最高三分位的患者年龄较大；体重指数较低；更有可能患有心房颤动并接受利尿剂治疗；并且左心房容积较大，肺动脉压较高，整体纵向应变的负值较小。LVEF 和收缩压在 IVC 直径的三分位之间相似。IVC 直径与 log [NT-proBNP] 相关（r=0.55，p<0.001）。在随访期间，158 名患者达到了主要终点。在多变量 Cox 回归模型中，包括 NT-proBNP，只有 IVC 直径增加、尿素和三尖瓣收缩期梯度独立预测不良预后。整体纵向应变和 LVEF 均不是不良预测因子。
在伴有或不伴有 LVEF 降低的慢性 HF 患者中，IVC 直径增加可识别出预后不良的患者。
