Inferior Vena Cava Diameter (IVCD) Measured with Transesophageal Echocardiography (TEE) can be used to derive the Central Venous Pressure (CVP) in anesthetized mechanically ventilated patients

Mary Ewurabena Arthur, Carolyn Landolfo, Marlene Wade, Manuel R Castresana

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Estimation of right atrial pressure (RAP) from variations in the diameter of the inferior vena cava (IVC) during the respiratory cycle using transthoracic echocardiography (TTE) is used routinely to calculate pulmonary artery systolic pressure, adding to right ventricular systolic pressure (RVSP) from the jet velocity of tricuspid regurgitation. Using transesophageal echocardiography (TEE) we sought to determine if the inferior vena cava diameter (IVCD) could be used to derive the central venous pressure (CVP) in anesthetized, mechanically ventilated patients. Methods: The IVCD was measured in its long axis (bicaval view) at the cavo-atrial junction using TEE and ECG synchronization (to coincide with the end of the T-wave) in 95 anesthetized, mechanically ventilated patients undergoing elective cardiac surgery. Each patient received a pulmonary artery catheter (PAC) that allowed for continuous monitoring of the CVP. Three independent readers were assigned to document the IVCD and the CVP. Statistical analysis was performed using bivariate correlation, variance (ANOVA), linear regression, Bland-Altman and Passing-Bablock analysis of agreement. Results: The IVCD measured in millimeters at the cavo-atrial junction showed a positive correlation with the CVP (n = 95, r = 0.860, P < 0.0001, r2 = 0.737, P < 0.0001). The linear regression equation [CVPc = (IVCD-4.004/0.751] was prospectively tested in a cohort of 12 anesthetized, mechanically ventilated patients under various hemodynamic conditions with a good correlation between the mean CVP (CVPm) and the calculated CVP (CVPc) (r = 0.923, P < 0.0001, r2 = 0.851, P < 0.0001). Conclusion: The TEE measured IVCD at the cavo-atrial junction showed a statistically significant correlation with the mean CVP. Using an equation derived from linear regression analysis, a reliable CVP can be estimated from the IVCD.

Original languageEnglish (US)
Pages (from-to)140-149
Number of pages10
JournalEchocardiography
Volume26
Issue number2
DOIs
StatePublished - Feb 1 2009

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Central Venous Pressure
Transesophageal Echocardiography
Inferior Vena Cava
Linear Models
Pulmonary Artery
Blood Pressure
Tricuspid Valve Insufficiency
Atrial Pressure
Ventricular Pressure
Thoracic Surgery
Echocardiography
Analysis of Variance
Electrocardiography
Catheters
Hemodynamics
Regression Analysis

Keywords

  • Central venous pressure (CVP)
  • Inferior vena cava diameter (IVCD)
  • Transesophageal echocardiography (TEE)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{c4bb7e65ea37416faf166f47c876bee6,
title = "Inferior Vena Cava Diameter (IVCD) Measured with Transesophageal Echocardiography (TEE) can be used to derive the Central Venous Pressure (CVP) in anesthetized mechanically ventilated patients",
abstract = "Background: Estimation of right atrial pressure (RAP) from variations in the diameter of the inferior vena cava (IVC) during the respiratory cycle using transthoracic echocardiography (TTE) is used routinely to calculate pulmonary artery systolic pressure, adding to right ventricular systolic pressure (RVSP) from the jet velocity of tricuspid regurgitation. Using transesophageal echocardiography (TEE) we sought to determine if the inferior vena cava diameter (IVCD) could be used to derive the central venous pressure (CVP) in anesthetized, mechanically ventilated patients. Methods: The IVCD was measured in its long axis (bicaval view) at the cavo-atrial junction using TEE and ECG synchronization (to coincide with the end of the T-wave) in 95 anesthetized, mechanically ventilated patients undergoing elective cardiac surgery. Each patient received a pulmonary artery catheter (PAC) that allowed for continuous monitoring of the CVP. Three independent readers were assigned to document the IVCD and the CVP. Statistical analysis was performed using bivariate correlation, variance (ANOVA), linear regression, Bland-Altman and Passing-Bablock analysis of agreement. Results: The IVCD measured in millimeters at the cavo-atrial junction showed a positive correlation with the CVP (n = 95, r = 0.860, P < 0.0001, r2 = 0.737, P < 0.0001). The linear regression equation [CVPc = (IVCD-4.004/0.751] was prospectively tested in a cohort of 12 anesthetized, mechanically ventilated patients under various hemodynamic conditions with a good correlation between the mean CVP (CVPm) and the calculated CVP (CVPc) (r = 0.923, P < 0.0001, r2 = 0.851, P < 0.0001). Conclusion: The TEE measured IVCD at the cavo-atrial junction showed a statistically significant correlation with the mean CVP. Using an equation derived from linear regression analysis, a reliable CVP can be estimated from the IVCD.",
keywords = "Central venous pressure (CVP), Inferior vena cava diameter (IVCD), Transesophageal echocardiography (TEE)",
author = "Arthur, {Mary Ewurabena} and Carolyn Landolfo and Marlene Wade and Castresana, {Manuel R}",
year = "2009",
month = "2",
day = "1",
doi = "10.1111/j.1540-8175.2008.00772.x",
language = "English (US)",
volume = "26",
pages = "140--149",
journal = "Echocardiography",
issn = "0742-2822",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Inferior Vena Cava Diameter (IVCD) Measured with Transesophageal Echocardiography (TEE) can be used to derive the Central Venous Pressure (CVP) in anesthetized mechanically ventilated patients

AU - Arthur, Mary Ewurabena

AU - Landolfo, Carolyn

AU - Wade, Marlene

AU - Castresana, Manuel R

PY - 2009/2/1

Y1 - 2009/2/1

N2 - Background: Estimation of right atrial pressure (RAP) from variations in the diameter of the inferior vena cava (IVC) during the respiratory cycle using transthoracic echocardiography (TTE) is used routinely to calculate pulmonary artery systolic pressure, adding to right ventricular systolic pressure (RVSP) from the jet velocity of tricuspid regurgitation. Using transesophageal echocardiography (TEE) we sought to determine if the inferior vena cava diameter (IVCD) could be used to derive the central venous pressure (CVP) in anesthetized, mechanically ventilated patients. Methods: The IVCD was measured in its long axis (bicaval view) at the cavo-atrial junction using TEE and ECG synchronization (to coincide with the end of the T-wave) in 95 anesthetized, mechanically ventilated patients undergoing elective cardiac surgery. Each patient received a pulmonary artery catheter (PAC) that allowed for continuous monitoring of the CVP. Three independent readers were assigned to document the IVCD and the CVP. Statistical analysis was performed using bivariate correlation, variance (ANOVA), linear regression, Bland-Altman and Passing-Bablock analysis of agreement. Results: The IVCD measured in millimeters at the cavo-atrial junction showed a positive correlation with the CVP (n = 95, r = 0.860, P < 0.0001, r2 = 0.737, P < 0.0001). The linear regression equation [CVPc = (IVCD-4.004/0.751] was prospectively tested in a cohort of 12 anesthetized, mechanically ventilated patients under various hemodynamic conditions with a good correlation between the mean CVP (CVPm) and the calculated CVP (CVPc) (r = 0.923, P < 0.0001, r2 = 0.851, P < 0.0001). Conclusion: The TEE measured IVCD at the cavo-atrial junction showed a statistically significant correlation with the mean CVP. Using an equation derived from linear regression analysis, a reliable CVP can be estimated from the IVCD.

AB - Background: Estimation of right atrial pressure (RAP) from variations in the diameter of the inferior vena cava (IVC) during the respiratory cycle using transthoracic echocardiography (TTE) is used routinely to calculate pulmonary artery systolic pressure, adding to right ventricular systolic pressure (RVSP) from the jet velocity of tricuspid regurgitation. Using transesophageal echocardiography (TEE) we sought to determine if the inferior vena cava diameter (IVCD) could be used to derive the central venous pressure (CVP) in anesthetized, mechanically ventilated patients. Methods: The IVCD was measured in its long axis (bicaval view) at the cavo-atrial junction using TEE and ECG synchronization (to coincide with the end of the T-wave) in 95 anesthetized, mechanically ventilated patients undergoing elective cardiac surgery. Each patient received a pulmonary artery catheter (PAC) that allowed for continuous monitoring of the CVP. Three independent readers were assigned to document the IVCD and the CVP. Statistical analysis was performed using bivariate correlation, variance (ANOVA), linear regression, Bland-Altman and Passing-Bablock analysis of agreement. Results: The IVCD measured in millimeters at the cavo-atrial junction showed a positive correlation with the CVP (n = 95, r = 0.860, P < 0.0001, r2 = 0.737, P < 0.0001). The linear regression equation [CVPc = (IVCD-4.004/0.751] was prospectively tested in a cohort of 12 anesthetized, mechanically ventilated patients under various hemodynamic conditions with a good correlation between the mean CVP (CVPm) and the calculated CVP (CVPc) (r = 0.923, P < 0.0001, r2 = 0.851, P < 0.0001). Conclusion: The TEE measured IVCD at the cavo-atrial junction showed a statistically significant correlation with the mean CVP. Using an equation derived from linear regression analysis, a reliable CVP can be estimated from the IVCD.

KW - Central venous pressure (CVP)

KW - Inferior vena cava diameter (IVCD)

KW - Transesophageal echocardiography (TEE)

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