Sonography of the inferior vena cava for the diagnosis and monitoring of treatment in patients with chronic congestive heart failure

Objective: This prospective clinical study investigated whether the relativ ely simple and cost-effective ultrasonography of the inferior vena cava (IV C) represents a valid clinical tool to assess the effectiveness of diuretic therapy in patients with chronic congestive heart failure (CHF). Methods: Measurement of the resting and inspiratory diameter of the VCI rep eatedly during diuretic therapy in 23 consecutive patients (11 women, 70 +/ - 10 years) with CHF and comparing the results to the daily measured body w eight and serum creatinine in these patients. Results were compared with th e IVC diameter obtained in 33 healthy controls (16 women, 42 +/- 15 years). In addition, the IVC collapse index was calculated to assess inspiratory m ovements of the IVC in patients on day 1 and 10 of therapy. Results: The IVC diameter at rest was 2.4 +/- 0.6cm and decreased to 2.0 +/ - 0.7cm at inspiration, which was significantly greater than in healthy con trols (1.4 +/- 0.4cm at rest and 1.05 +/- 0.5cm at inspiration; p = 0.008 a nd p = 0.01, respectively), The IVC diameter decreased continuously and sig nificantly (p < 0.003) from day 1 to day 10 during diuretic therapy without a concomitant rise in serum creatinine. At beginning of therapy, the colla pse-index of the IVC was significantly greater in patients than in controls . However, after 10 days of therapy this index reached similar values to th ose observed in controls. Conclusion: Ultrasonographic measurements of IVC diameter and inspiratory m ovements are a quantifiable and reliable approach to assess the hypervolemi a associated with CHF. Normalization of inspiratory IVC collapse movement c orrelates with successful diuretic therapy and can be reliably used for bed side assessment and monitoring treatment in CHF patients.