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Review
. 2022 Feb 7;12(2):427.
doi: 10.3390/diagnostics12020427.

Inferior Vena Cava Edge Tracking Echocardiography: A Promising Tool with Applications in Multiple Clinical Settings

Stefano Albani  1   2 , Luca Mesin  3 , Silvestro Roatta  4 , Antonio De Luca  2 , Alberto Giannoni  5   6 , Davide Stolfo  2 , Lorenza Biava  1 , Caterina Bonino  1 , Laura Contu  1 , Elisa Pelloni  1 , Emilio Attena  7 , Vincenzo Russo  7 , Francesco Antonini-Canterin  8 , Nicola Riccardo Pugliese  9 , Guglielmo Gallone  10 , Gaetano Maria De Ferrari  10 , Gianfranco Sinagra  2 , Paolo Scacciatella  1
Affiliations
Review

Inferior Vena Cava Edge Tracking Echocardiography: A Promising Tool with Applications in Multiple Clinical Settings

Stefano Albani et al. Diagnostics (Basel). .

Abstract

Ultrasound (US)-based measurements of the inferior vena cava (IVC) diameter are widely used to estimate right atrial pressure (RAP) in a variety of clinical settings. However, the correlation with invasively measured RAP along with the reproducibility of US-based IVC measurements is modest at best. In the present manuscript, we discuss the limitations of the current technique to estimate RAP through IVC US assessment and present a new promising tool developed by our research group, the automated IVC edge-to-edge tracking system, which has the potential to improve RAP assessment by transforming the current categorical classification (low, normal, high RAP) in a continuous and precise RAP estimation technique. Finally, we critically evaluate all the clinical settings in which this new tool could improve current practice.

Keywords: caval index; edge tracking; heart failure; inferior vena cava; pulmonary hypertension; right atrial pressure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Recordings from a healthy subject: from top to bottom, cardiac component of IVC pulsatility (Dc-IVC), respiratory component (Dr-IVC), unfiltered IVC pulsatility (D-IVC), arterial blood pressure (ABP), respiratory movements (Resp), long axis IVC imaging was processed according to Mesin et al., 2019 [24].
Figure 2
Figure 2
Critical issues on RAP estimation by using IVC diameters. Top left: different breathing manners studied with US M-mode of the diaphragm. Top right: different proposed sites of measurement of the IVC. Bottom left: effect of the vein movement on the IVC diameter measurement showing foreshortening of the vein due to the respiratory cycle (A: latero-lateral displacement, B: cranio-caudal displacement) [12]. Bottom right: causes of unreliability of the IVC in RAP estimation [2]. Center: the proposed new IVC edge-to-edge tracking technique (adapted from Blehar et al. [12] and Wallace et al. [27]).
Figure 3
Figure 3
Panel (A): IVC tracking technique: the software is able to identify the vessel (IVC long axis view) (top) of interest and perform the edge tracking of five fixed points along both edges of the vessel (bottom). Panel (B): the results of the edge tracking techniques are shown: respiratory (top) and cardiac (bottom) components are represented. (Bold line graphic on top: respiratory component of the IVC diameter variation (mm). Bold line graphic at the bottom: cardiac component of the IVC diameter variation (mm). Non-bold line in both graphics: IVC diameter variation during two breaths). Panel (C): a US IVC scan in short axis view is shown; red arrows indicate the direction of the collapsibility of the vessel walls that is not directed in an antero-posterior way, rather the main direction is medio-lateral. Panel (D) shows a possible solution to perform a more reliable IVC study: the use of the three-dimensional x-plane echocardiography, to gain the possibility to evaluate in real-time both long and short axis views (adapted from Mesin et al. [8]).
Figure 4
Figure 4
Our edge tracking technique could be applied in multiple clinical settings (see the text for further explanations).
Figure 5
Figure 5
Main advantages that could be provided by an extensive use of US IVC edge tracking echocardiography (see text for further explanations).
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