Clinical Heart and Vascular Center

Hemodynamics and Congestion in Heart Failure: A Poster Session Review

By E. Ashley Hardin, M.D.

Assistant Professor of Internal Medicine

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Dr. E. Ashley Hardin

There was a plethora of interesting data presented during the “Hemodynamics and Congestion in Heart Failure” poster session this year at #AHA20. Several abstracts focused on a) the role of noninvasive assessment of intravascular volume status using ultrasound technology and b) the significance of the physical exam in patients admitted with heart failure. In one study, the size and collapsibility of the inferior vena cava (IVC) and subclavian vein (SCV) were assessed to estimate right atrial pressure (RAP) and subsequently compared to simultaneous invasive hemodynamic measurements. The correlation of RAP to SCV measurements was higher than that of traditional IVC measurements. Another study investigated the utility of a portable ultrasound device to measure the internal jugular vein (IJV) for estimation of RAP in obese vs. non-obese patients. The authors found that bedside ultrasound assessment of RAP was superior to standard visual assessment of the IJV as compared to invasive hemodynamic assessment, particularly in the obese patient population.

“Several abstracts focused on a) the role of noninvasive assessment of intravascular volume status using ultrasound technology and b) the significance of the physical exam in patients admitted with heart failure.”

E. Ashley Hardin, M.D.

It is worth highlighting another interesting study that investigated temporal trends and prognosis of the physical exam in patients hospitalized with acute decompensated heart failure. In this analysis, bedside clinical assessment of volume status was based on jugular venous distension (JVD), lower extremity edema (LEE), and pulmonary rales in a contemporary cohort of patients admitted with any heart failure, irrespective of the ejection fraction. The authors concluded that the presence of edema on physical exam has increased in recent years, whereas the presence of JVD and rales have remained similar. The prognostic utility of the three physical exam signs of congestion differed by heart failure type, with the presence of all three predictive of higher short- and long-term mortality in the HFpEF but not HFrEF population.

Follow Dr. E. Ashley Hardin:

Twitter: @EAshleyHardinMD

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