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Diagnostic accuracy of inferior vena cava ultrasound for heart failure in patients with acute dyspnoea: a systematic review and meta-analysis
  1. Alessandro Squizzato1,
  2. Lorenzo Maroni2,
  3. Cristina Marrazzo3,
  4. Nicoletta Riva4,
  5. Luigina Guasti1
  1. 1 Medicine and Surgery, University of Insubria, Varese/Como, Italy
  2. 2 Internal Medicine, Sant'Antonio Abate Hospital, Gallarate, Italy
  3. 3 Oncology, University of Pavia, Varese, Italy
  4. 4 Pathology, University of Malta, Msida, Malta
  1. Correspondence to Professor Alessandro Squizzato, UOC Medicina Generale, Ospedale Sant'Anna - ASST Lariana, via Ravona 20 - 22042 San Fermo della Battaglia (Como), Italy; alessandro.squizzato{at}


Background Dyspnoea is the most common sign of heart failure (HF). Patients accessing the ED for HF-related symptoms require fast diagnosis and early treatment. Transthoracic echocardiography has a crucial role in HF diagnosis, but requires qualified staff and adequate time for execution. The measurement of inferior vena cava (IVC) diameter has been recently proposed as a rapid, simple and reliable marker of volume overload. The aim of this systematic review was to assess the accuracy of IVC-ultrasound as a stand-alone test for HF diagnosis in patients presenting to the ED with acute dyspnoea.

Methods Studies evaluating the diagnostic accuracy of the inferior vena cava collapsibility index (IVC-CIx) for HF diagnosis were systematically searched in the EMBASE and MEDLINE databases (up to January 2018). Quality Assessment of Diagnostic Accuracy Studies 2 tool was used for the quality assessment of the primary studies. A bivariate random-effects regression approach was used for summary estimates of both sensitivity and specificity.

Results Seven studies, for a total of 591 patients, were included. Three studies were at low-risk of bias. All studies used a proper reference test. Weighted mean prevalence of HF was 49.3% at random-effect model (I2 index for heterogeneity=74.7%). IVC-CIx bivariate weighted mean sensitivity was 79.1% (95% CI 68.5% to 86.8%) and bivariate weighted mean specificity was 81.8% (95% CI 75.0% to 87.0%).

Conclusions Our findings suggest that the sensitivity and specificity of IVC-CIx are suboptimal to rule in or rule out HF diagnosis in patients with acute dyspnoea in the ED setting. Therefore, IVC-CIx is not advisable as a stand-alone test, but may be useful when integrated in a specific diagnostic algorithm for the differential diagnosis of acute dyspnoea.

  • imaging
  • ultrasound
  • heart failure
  • ED

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  • Handling editor Simon Carley

  • Twitter @NicolettaRivaMD

  • Contributors AS: conceiving, designing and coordinating the review; data interpretation; codrafting of the paper. LM: searching for and selecting studies; data extraction; data interpretation; codrafting of the paper. CM: searching for and selecting studies; data extraction; data interpretation; drafting of the paper. NR: data analysis; data interpretation; codrafting of the paper. LG: providing general advices; codrafting of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.