A New Kid On The Block? The Challenges and Advantages Of Using The Three-Point Ultrasound Score to Assess Volume Status in Patients With Obesity

The use of a point-of-care ultrasound or echocardiography to assess patients' hemodynamics has been widely adopted in clinical practice. Conventionally, the assessment of the inferior vena cava (IVC) diameter and its vessel collapsibility with inspiratory or expiratory variability, in addition to the sniff test, is used to estimate the right atrial pressure (RAP). 1 Rudski LG Lai WW Afilalo J Hua L Handschumacher MD Chandrasekaran K Solomon SD Louie EK Schiller NB Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23 (quiz 786): 685-713 Abstract Full Text Full Text PDF PubMed Scopus (5444) Google Scholar , 2 Porter TR Shillcutt SK Adams MS Desjardins G Glas KE Olson JJ Troughton RW Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2015; 28: 40-56 Abstract Full Text Full Text PDF PubMed Scopus (315) Google Scholar , 3 Kircher BJ Himelman RB Schiller NB Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990; 66: 493-496 Abstract Full Text PDF PubMed Scopus (872) Google Scholar This noninvasive assessment of RAP, without performing a right-sided cardiac catheterization, is an efficient and feasible approach available to all providers. However, acquiring optimal sonographic views to assess the IVC can be limited by the presence of bowel gas or ascites, or by body habitus. In fact, using different thresholds for the IVC diameter has been suggested to evaluate high RAP in relation to a patient's body surface area (BSA) or gender differences. 4 Taniguchi T Ohtani T Nakatani S Hayashi K Yamaguchi O Komuro I Sakata Y Impact of body size on inferior vena cava parameters for estimating right atrial pressure: a need for standardization?. J Am Soc Echocardiogr. 2015; 28: 1420-1427 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar For instance, a threshold of ≥21 mm is sufficient for a larger BSA, whereas a new threshold of ≥17 mm is possibly a more accurate measurement in estimating RAP in patients with a smaller BSA. 4 Taniguchi T Ohtani T Nakatani S Hayashi K Yamaguchi O Komuro I Sakata Y Impact of body size on inferior vena cava parameters for estimating right atrial pressure: a need for standardization?. J Am Soc Echocardiogr. 2015; 28: 1420-1427 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar Evaluation of Right-Side Filling Pressure in Patients With Obesity With Heart Failure Using Handheld Ultrasound ScoreAmerican Journal of CardiologyVol. 210PreviewThe goal of this investigation is to evaluate the accuracy of handheld ultrasound score in assessing right atrial (RA) pressure in patients with obesity with heart failure. We prospectively studied 123 patients with heart failure referred for right-sided cardiac catheterization. Handheld ultrasound was performed before catheterization to evaluate volume status by estimating RA pressure using end-expiratory inferior vena cava (IVC) dimension, IVC respiratory collapsibility, and right internal jugular (RIJ) vein respiratory collapsibility. Full-Text PDF