Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia.
Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.
BMC Cardiovasc Disord. 2023 Nov 24;23(1):579. doi: 10.1186/s12872-023-03585-1.
Inferior vena cava (IVC) diameter variability with respiration measured by ultrasound was found to be useful for the diagnosis of heart failure (HF) in ED patients with acute dyspnea. Its value in identifying HF in acute exacerbation of chronic obstructive pulmonary disease exacerbation (AECOPD) was not specifically demonstrated.
To determine the value of ΔIVC in the diagnosis of HF patients with AECOPD.
This is a prospective study conducted in the ED of three Tunisian university hospitals including patients with AECOPD. During this period, 401 patients met the inclusion criteria. The final diagnosis of HF is based on the opinion of two emergency experts after consulting the data from clinical examination, cardiac echocardiography, and BNP level. The ΔIVC was calculated by two experienced emergency physicians who were blinded from the patient's clinical and laboratory data. A cut off of 15% was used to define the presence (< 15%) or absence of HF (≥ 15%). Left ventricular ejection fraction (LVEF) was also measured. The area under the ROC curve, sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic and predictive accuracy of the ΔIVC in predicting HF.
The study population included 401 patients with AECOPD, mean age 67.2 years with male (68.9%) predominance. HF was diagnosed in 165 (41.1%) patients (HF group) and in 236 patients (58.9%) HF was excluded (non HF group). The assessment of the performance of the ΔIVC in the diagnosis of HF showed a sensitivity of 37.4% and a specificity of 89.7% using the threshold of 15%. The positive predictive value was 70.9% and the negative predictive value was 66.7%. The area under the ROC curve was 0.71(95%, CI 0.65-0.76). ΔIVC values were not different between HF patients with reduced LVEF and those with preserved LVEF.
Our results showed that ΔIVC has a good value for ruling out HF in ED patients consulting for AECOPD.
研究发现，通过超声测量下腔静脉（IVC）直径随呼吸变化对 ED 中急性呼吸困难的心力衰竭（HF）患者的诊断具有一定的价值。然而，其在慢性阻塞性肺疾病急性加重（AECOPD）患者中的诊断价值尚未得到明确。
评估 ΔIVC 在诊断 AECOPD 合并 HF 患者中的价值。
这是一项在三家突尼斯大学医院急诊科进行的前瞻性研究，纳入 AECOPD 患者。在此期间，符合纳入标准的患者共 401 例。HF 的最终诊断是基于两位急诊专家在综合临床检查、心脏超声和 BNP 水平等数据后得出的意见。ΔIVC 由两名经验丰富的急诊医生通过测量计算得出，其在测量过程中不了解患者的临床和实验室数据。采用 15%作为截断值，以定义 HF 的存在（<15%）或不存在（≥15%）。同时还测量了左心室射血分数（LVEF）。计算 ROC 曲线下面积、敏感度、特异度、阳性和阴性预测值，以确定 ΔIVC 预测 HF 的诊断和预测准确性。
本研究共纳入 401 例 AECOPD 患者，平均年龄为 67.2 岁，男性（68.9%）居多。其中 165 例（41.1%）患者被诊断为 HF（HF 组），236 例（58.9%）排除 HF（非 HF 组）。评估 ΔIVC 对 HF 诊断的效能，结果显示，当截断值为 15%时，ΔIVC 的敏感度为 37.4%，特异度为 89.7%。阳性预测值为 70.9%，阴性预测值为 66.7%。ROC 曲线下面积为 0.71（95%CI 0.65-0.76）。HF 患者中 LVEF 降低与 LVEF 正常的患者 ΔIVC 值无差异。
本研究结果表明，在 ED 中因 AECOPD 就诊的患者中，ΔIVC 对排除 HF 具有较好的价值。
