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CAVA-ADHF-DZHK10

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-DZHK10)

This is examining whether an ultrasound evaluation of the inferior vena cava in acute decompensated heart failure (ADHF) with congestion can be implemented in hospitals’ everyday routine and also be conducted in a sufficiently large number of patients. In the long term, the scientists want to offer patients a more targeted and better treatment with the aid of this ultrasound evaluation.

In heart failure, the filling pressure in the heart is elevated, since the normal filling pressure is no longer enough to supply the body with enough blood and oxygen at all times. As a result, the pressure in the vessels leading to the heart, such as the inferior vena cava, also increases. The vena cava is one of the largest veins and it carries deoxygenated blood from the abdomen, legs and pelvis back to the heart. In ADHF, its diameter increases due to the elevated pressure. Moreover, fluid increasingly finds its way into the surrounding tissue (i.e. oedema). An infection, cardiac arrhythmias, excessive fluid intake, or poor adherence to medical treatment can all be triggers of the sudden development of a previously undetected or chronic heart failure into an acute decompensated heart failure. Loop diuretics were used, which remove excess fluid from the body and, among other things, relieve the cardiovascular system by reducing the filling pressure. To date, clinical signs are used for this purpose; for instance, whether the patient lost weight, his oedema could be reduced, or dyspnoea improved. However, these signs are not specific for heart failure and this new clinical trial wants to close this gap. Physicians assess the patient’s inferior vena cava diameter by means of an ultrasound evaluation before and during treatment. They want to test whether the diameter of the vein decreases with therapy and is a suitable parameter to assess whether the treatment is sufficient; or whether it would be better to treat the patient for a couple more days or to increase the loop diuretic dose. If this assumption is verified, further clinical trials must prove that the ultrasound evaluation can lead to a more targeted treatment and thus also to a more favourable course of the disease in ADHF.

Please use the following link to get to the website of the study https://cava-adhf.dzhk.de/

Principal Investigators

Principal investigator: Alexander Jobs (Lübeck), Co-PI: Holger Thiele (Leipzig)

Medical institution

Universitätsklinikum Schleswig Holstein, Campus Lübeck

Keywords

acute decompensated heart failure

Recruitment start

07/2017

Patients (planned)

388

Patients (recruited)

389 (completed)

ClinicalTrials.gov

NCT03140566