Inferior Vena Cava Ultrasound to Guide Decongestion in Acute Decompensated Heart Failure: A Randomized Controlled Trial
Abstract
BACKGROUND
Residual congestion at hospital discharge after an episode of acute decompensated heart failure (ADHF) is associated with poor prognosis. There is no consensus on how optimal decongestion should be assessed.
OBJECTIVES
This study aims to determine whether decongestive therapy guided by ultrasound measurements of inferior vena cava (IVC) diameters leads to greater reductions in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels from baseline to hospital discharge as compared with decongestion treatment guided by clinical assessment alone.
METHODS
In a randomized controlled multicenter trial, patients admitted for ADHF (NYHA functional class ≥III) exhibiting signs of pulmonary congestion, peripheral edema, and NT-proBNP levels >300 ng/L were randomized to either decongestion therapy guided by daily IVC ultrasound plus clinical assessment or clinical assessment alone. The primary endpoint was the change in NT-proBNP levels from baseline to discharge.
RESULTS
A total of 388 patients were randomized, of which 327 were included in the primary intention-to-treat analysis. The between-group difference in primary endpoint of change in NT-proBNP levels was 5.4% (95% CI: -9.4% to 22.6%; P = 0.58). Safety events were numerically less frequent in the IVC ultrasound-guided group. No difference between groups was consistently observed in secondary endpoints with similar rates of hemoconcentration and intensity of diuretic treatment.
CONCLUSIONS
Additional ultrasound…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 388 participants or records.
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