Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.
DZHK (German Centre for Cardiovascular Research).
ESC Heart Fail. 2020 Jun;7(3):973-983. doi: 10.1002/ehf2.12598. Epub 2020 Jan 28.
Treating patients with acute decompensated heart failure (ADHF) presenting with volume overload is a common task. However, optimal guidance of decongesting therapy and treatment targets are not well defined. The inferior vena cava (IVC) diameter and its collapsibility can be used to estimate right atrial pressure, which is a measure of right-sided haemodynamic congestion. The CAVA-ADHF-DZHK10 trial is designed to test the hypothesis that ultrasound assessment of the IVC in addition to clinical assessment improves decongestion as compared with clinical assessment alone.
CAVA-ADHF-DZHK10 is a randomized, controlled, patient-blinded, multicentre, parallel-group trial randomly assigning 388 patients with ADHF to either decongesting therapy guided by ultrasound assessment of the IVC in addition to clinical assessment or clinical assessment alone. IVC ultrasound will be performed daily between baseline and hospital discharge in all patients. However, ultrasound results will only be reported to treating physicians in the intervention group. Treatment target is relief of congestion-related signs and symptoms in both groups with the additional goal to reduce the IVC diameter ≤21 mm and increase IVC collapsibility >50% in the intervention group. The primary endpoint is change in N-terminal pro-brain natriuretic peptide from baseline to hospital discharge. Secondary endpoints evaluate feasibility, efficacy of decongestion on other scales, and the impact of the intervention on clinical endpoints.
CAVA-ADHF-DZHK10 will investigate whether IVC ultrasound supplementing clinical assessment improves decongestion in patients admitted for ADHF.
治疗伴有容量超负荷的急性失代偿性心力衰竭（ADHF）患者是一项常见任务。然而，利尿治疗和治疗目标的最佳指导尚未明确。下腔静脉（IVC）直径及其可塌陷性可用于估计右心房压力，这是右心血液动力学充血的一种衡量标准。CAVA-ADHF-DZHK10 试验旨在检验以下假设，即与仅临床评估相比，超声评估 IVC 加上临床评估可改善充血消退。
CAVA-ADHF-DZHK10 是一项随机、对照、患者设盲、多中心、平行组试验，将 388 例 ADHF 患者随机分为超声评估 IVC 联合临床评估的利尿治疗组或仅临床评估组。所有患者在基线和出院期间每天进行 IVC 超声检查。然而，仅在干预组向治疗医生报告超声结果。两组的治疗目标都是缓解充血相关症状和体征，干预组的额外目标是将 IVC 直径缩小≤21mm 并增加 IVC 可塌陷性>50%。主要终点是从基线到出院时 N 末端脑利钠肽前体的变化。次要终点评估可行性、其他量表利尿效果以及干预对临床终点的影响。
CAVA-ADHF-DZHK10 将研究 IVC 超声补充临床评估是否可改善因 ADHF 入院患者的充血消退。
