UPEC, AP-HP Henri Mondor University Hospital, Creteil, France; INSERM U955, Creteil, France; DHU ATVB, Creteil, France.
UPEC, AP-HP Henri Mondor University Hospital, Creteil, France; INSERM U955, Creteil, France; DHU ATVB, Creteil, France.
J Am Soc Echocardiogr. 2018 Sep;31(9):1034-1043. doi: 10.1016/j.echo.2018.04.003. Epub 2018 Jun 13.
The inferior vena cava (IVC) has a complex three-dimensional (3D) shape, but measurements used to estimate central venous pressure (CVP) remain based on two-dimensional (2D) echocardiographic imaging. The aim of this study was to investigate the accuracy of IVC size and collapsibility index obtained by 3D echocardiography for assessing CVP in patients with cardiogenic shock.
Eighty consecutive echocardiographic examinations performed in 33 patients (mean age, 72 ± 15 years; mean left ventricular ejection fraction, 19 ± 10%) admitted for cardiogenic shock were prospectively included. Two-dimensional and 3D images of the IVC were acquired simultaneously with invasive measurement of CVP, both at rest and during a sniff test. IVC diameters, 3D IVC area, and IVC collapsibility index (IVCCI) were assessed. The eccentricity index was computed from 3D data as the ratio of maximum to minimum IVC diameter. A cutoff value of 10 mm Hg for CVP defined patients with euvolemic hemodynamic status.
At rest, IVC diameter averaged 23 ± 7 mm by 2D imaging and 25 ± 8 × 19 ± 7 mm by 3D imaging. The IVC had an eccentric shape (eccentricity index = 1.3) that increased when CVP was ≤10 mm Hg and during the sniff test (P < .001). IVC measurements by 2D and 3D imaging were correlated with CVP. The best correlation was obtained with IVCCI derived from 2D diameters (R = -0.69) and 3D areas (R = -0.82). Using a cutoff value of 50% for IVCCI, 11 examinations were misclassified by 2D imaging and only one by 3D imaging. Inter- and intraobserver reproducibility for IVC area was 7 ± 6% and 5 ± 3%, respectively.
In patients with cardiogenic shock, IVCCI from area by 3D echocardiography is reproducible and accurate to evaluate CVP.
下腔静脉（IVC）具有复杂的三维（3D）形状，但用于估计中心静脉压（CVP）的测量值仍然基于二维（2D）超声心动图成像。本研究旨在探讨 3D 超声心动图测量下腔静脉大小和塌陷指数评估心源性休克患者 CVP 的准确性。
连续纳入 33 例心源性休克患者 80 例超声心动图检查（平均年龄 72±15 岁；平均左心室射血分数 19±10%）。同时采集 IVC 的 2D 和 3D 图像，并进行有创性 CVP 测量，在休息和嗅探试验时进行。评估 IVC 直径、3D IVC 面积和 IVC 塌陷指数（IVCCI）。从 3D 数据计算偏心指数，即 IVC 最大直径与最小直径之比。将 CVP 的 10mmHg 作为定义血容量正常的患者的截断值。
在休息时，2D 成像时 IVC 直径平均为 23±7mm，3D 成像时为 25±8×19±7mm。IVC 呈偏心形状（偏心指数=1.3），当 CVP≤10mmHg 时和嗅探试验时增加（P<0.001）。2D 和 3D 成像的 IVC 测量值与 CVP 相关。从 2D 直径（R=-0.69）和 3D 面积（R=-0.82）获得的 IVCCI 相关性最佳。使用 IVCCI 的 50%作为截断值，2D 成像有 11 次检查分类错误，而 3D 成像只有 1 次。IVC 面积的组内和组间重复性分别为 7±6%和 5±3%。
在心源性休克患者中，3D 超声心动图的 IVCCI 重复性好，可准确评估 CVP。
