DZHK Study: Better Therapy for Acute Heart Failure

A new clinical study carried out by the German Center for Cardiovascular Research (DZHK) checks whether an ultrasound examination of the lower vena cava can be carried out with congestive heart failure during acute decompensated heart failure and can also be carried out with a sufficiently large number of patients. In the long term, the scientists would like to use this ultrasound examination to treat patients more specifically and better.

acute heart failure
The ultrasound recordings show, for example, that the lower vena cava is often widened in patients with heart failure. Left: Patient with heart weakness; Right: healthy peers. (Photo: Universitätses Herzzentrum Lübeck)

In the case of cardiac insufficiency, the filling pressure in the heart is increased as the normal filling pressure is no longer sufficient to supply the body with sufficient blood and oxygen in any situation. This also increases the pressure in the vessels in front of the heart, like the lower vena cava. It is one of the largest veins and leads oxygen-deficient blood from the abdomen, the legs and the pelvis back to the heart.In the case of acute decompensated heart failure (ADHF), its diameter increases as a result of the increased pressure, and more fluid enters the surrounding tissue.

“An infection, cardiac arrhythmia, excessive fluid intake, or when the medication is not properly taken can be the trigger for an uninfected or chronic heart weakness suddenly developing into an acutely decompensated heart defect,” explains Dr. Alexander Jobs of the University Heart Center Lübeck. “The patients already suffer from respiratory distress, have increased water retention in the legs, are exhausted faster and often come to the emergency room.” The doctors use abrasive diuretics, which have a dehydrating effect and, among other things, a reduction of the filling pressure the cardio-vascular system System. However, there are no exact parameters that can determine when the treatment is successfully completed. Traditional clinical signs are available to them, for example, whether the patient has decreased, since there is not enough water left, or if he gets better air again. “These signs, however, are not very specific for cardiac insufficiency,” explains Prof. Holger Thiele, who heads the pilot study.

The new clinical study is intended to close this gap: Before and during treatment, the physicians examine the lower vena cava of the patients with ultrasound. They want to check whether the diameter of the vein decreases again under therapy and is a suitable parameter to assess whether the treatment is adequate or whether the patient should be treated a few days longer or the dose of the abrasion diuretics should be increased. If this assumption is confirmed, further clinical studies must prove that the ultrasound examination can lead to a more targeted treatment and thus to a more favorable course of disease in ADHF. ADHF is the most common cause of hospital treatment for over 65-year-olds in Germany. Within six months, about half of the patients return to the hospital and the repeated visits make their prognosis worse. A total of eight facilities at six DZHK locations are participating in the pilot study.

: Ultrasound evaluation of the inferior vena cava in addition to clinical assessment to guide decongestion in acute decompensated heart failure: a pilot study; CAVA-ADHF