JACC. Case reports · 2026
Bedside IVC Echocardiography to Distinguish Autonomic Dysfunction-Predominant Orthostasis From Right Ventricular Failure in Patients With LVADs.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Nenadic Ivan, Danyluk Alexandria, Rosario Karen Flores, Frazier-Mills Camille, Cox Kevin, Fudim Marat
Аннотация
OBJECTIVE: To present a bedside echocardiography approach using inferior vena cava size and collapsibility to distinguish between autonomic dysfunction-predominant orthostatic hypotension and right ventricular failure in symptomatic continuous-flow left ventricular assist device patients.
KEY STEPS: Identify patients with a continuous-flow left ventricular assist device and presenting orthostatic intolerance symptoms or low-flow alarms. Perform bedside echocardiography evaluating inferior vena cava size and collapsibility while the patient is supine, and again after standing for 3 to 5 minutes. Categorize findings. Right ventricular failure: Indicated by a plethoric, poorly collapsible inferior vena cava. Autonomic dysfunction-predominant orthostatic hypotension: Indicated by a small, highly collapsible inferior vena cava.
POTENTIAL PITFALLS: Failing to optimize volume status and device parameters prior to testing may lead to unclear or inaccurate clinical assessments.
TAKE-HOME MESSAGES: Autonomic dysfunction orthostatic hypotension is a frequently underrecognized complication of continuous-flow left ventricular assist device support caused by reduced pulsatility. Bedside assessment of inferior vena cava collapsibility serves as a method to identify the underlying phenotype and guide clinical management.
KEY STEPS: Identify patients with a continuous-flow left ventricular assist device and presenting orthostatic intolerance symptoms or low-flow alarms. Perform bedside echocardiography evaluating inferior vena cava size and collapsibility while the patient is supine, and again after standing for 3 to 5 minutes. Categorize findings. Right ventricular failure: Indicated by a plethoric, poorly collapsible inferior vena cava. Autonomic dysfunction-predominant orthostatic hypotension: Indicated by a small, highly collapsible inferior vena cava.
POTENTIAL PITFALLS: Failing to optimize volume status and device parameters prior to testing may lead to unclear or inaccurate clinical assessments.
TAKE-HOME MESSAGES: Autonomic dysfunction orthostatic hypotension is a frequently underrecognized complication of continuous-flow left ventricular assist device support caused by reduced pulsatility. Bedside assessment of inferior vena cava collapsibility serves as a method to identify the underlying phenotype and guide clinical management.