Inferior Vena Cava Ultrasound to Guide Decongestion in Acute Decompensated Heart Failure: A Randomized Controlled Trial

CAVA-ADHF-DZHK10 Investigators

doi:10.1016/j.jchf.2025.102578

Inferior Vena Cava Ultrasound to Guide Decongestion in Acute Decompensated Heart Failure: A Randomized Controlled Trial

CAVA-ADHF-DZHK10 Investigators

Abstract

Background: Residual congestion at hospital discharge after an episode of acute decompensated heart failure (ADHF) is associated with poor prognosis. There is no consensus on how optimal decongestion should be assessed. Objectives: This study aims to determine whether decongestive therapy guided by ultrasound measurements of inferior vena cava (IVC) diameters leads to greater reductions in N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels from baseline to hospital discharge as compared with decongestion treatment guided by clinical assessment alone. Methods: In a randomized controlled multicenter trial, patients admitted for ADHF (NYHA functional class ≥III) exhibiting signs of pulmonary congestion, peripheral edema, and NT-proBNP levels >300 ng/L were randomized to either decongestion therapy guided by daily IVC ultrasound plus clinical assessment or clinical assessment alone. The primary endpoint was the change in NT-proBNP levels from baseline to discharge. Results: A total of 388 patients were randomized, of which 327 were included in the primary intention-to-treat analysis. The between-group difference in primary endpoint of change in NT-proBNP levels was 5.4% (95% CI: −9.4% to 22.6%; P = 0.58). Safety events were numerically less frequent in the IVC ultrasound–guided group. No difference between groups was consistently observed in secondary endpoints with similar rates of hemoconcentration and intensity of diuretic treatment. Conclusions: Additional ultrasound evaluation of IVC diameters did not improve decongestion treatment compared with clinical assessment alone among patients admitted for ADHF. (Ultrasound Evaluation of the IVC in Addition to Clinical Assessment to Guide Decongestion in ADHF [CAVA-ADHF-DZHK10]; NCT03140566).

Originalsprache	Englisch
Aufsatznummer	102578
Zeitschrift	JACC: Heart Failure
Jahrgang	13
Ausgabenummer	10
ISSN	2213-1779
DOIs	https://doi.org/10.1016/j.jchf.2025.102578
Publikationsstatus	Veröffentlicht - 10.2025

Fördermittel

The CAVA-ADHF trial was planned and conducted as an investigator-initiated, randomized, controlled, patient-blinded, multicenter, parallel-group trial without industry involvement. Details regarding the rationale and design have been published previously. 14 The trial protocol is available with the full text of this paper ( Supplemental Appendix: Study Protocol ) and was approved by the local ethics committees of each participating center. All patients provided written informed consent before any trial-specific procedure. The trial was fully funded by the DZHK (German Center for Cardiovascular Research). A data and safety monitoring board reviewed all safety aspects of the trial. A.J. designed the trial and drafted the trial protocol, which was modified during the review process, in accordance with feedback from the steering committee and experts at the DZHK. The trial design was finally approved by the steering committee. A.J. drafted the manuscript and all authors jointly decided to submit it for publication after review. As part of the sponsor's data confidentiality requirements, all trial site investigators, including the authors, signed confidentiality agreements. The steering committee and trial statistician, respectively, vouch for the accuracy and completeness of the data, and the precision of the data analysis in adherence to the trial protocol.

Träger	Trägernummer
Deutsches Zentrum für Herz-Kreislaufforschung

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10.1016/j.jchf.2025.102578

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@article{1cca9cc52e5947c0a22140b4d09b494f,

title = "Inferior Vena Cava Ultrasound to Guide Decongestion in Acute Decompensated Heart Failure: A Randomized Controlled Trial",

abstract = "Background: Residual congestion at hospital discharge after an episode of acute decompensated heart failure (ADHF) is associated with poor prognosis. There is no consensus on how optimal decongestion should be assessed. Objectives: This study aims to determine whether decongestive therapy guided by ultrasound measurements of inferior vena cava (IVC) diameters leads to greater reductions in N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels from baseline to hospital discharge as compared with decongestion treatment guided by clinical assessment alone. Methods: In a randomized controlled multicenter trial, patients admitted for ADHF (NYHA functional class ≥III) exhibiting signs of pulmonary congestion, peripheral edema, and NT-proBNP levels >300 ng/L were randomized to either decongestion therapy guided by daily IVC ultrasound plus clinical assessment or clinical assessment alone. The primary endpoint was the change in NT-proBNP levels from baseline to discharge. Results: A total of 388 patients were randomized, of which 327 were included in the primary intention-to-treat analysis. The between-group difference in primary endpoint of change in NT-proBNP levels was 5.4\% (95\% CI: −9.4\% to 22.6\%; P = 0.58). Safety events were numerically less frequent in the IVC ultrasound–guided group. No difference between groups was consistently observed in secondary endpoints with similar rates of hemoconcentration and intensity of diuretic treatment. Conclusions: Additional ultrasound evaluation of IVC diameters did not improve decongestion treatment compared with clinical assessment alone among patients admitted for ADHF. (Ultrasound Evaluation of the IVC in Addition to Clinical Assessment to Guide Decongestion in ADHF [CAVA-ADHF-DZHK10]; NCT03140566).",

author = "\{CAVA-ADHF-DZHK10 Investigators\} and Alexander Jobs and Rausch, \{Tanja K.\} and K{\"o}nig, \{Inke R.\} and Reinhard Vonthein and Ashika Devendra and Jane Sch{\"a}fer and Matthias Nauck and Ingo Eitel and Thomas Stiermaier and Laugwitz, \{Karl Ludwig\} and Jakob Ledwoch and Miroslava Valentova and \{von Haehling\}, Stephan and Stefan St{\"o}rk and Natalie Arnold and Mahir Karakas and Dirk Westermann and Tobias Lenz and Tommaso Gori and Frank Edelmann and Philipp Seppelt and Felix, \{Stephan B.\} and Matthias Lutz and Felix Hedwig and Ibrahim Akin and Clemens Scherer and Steffen Desch and Holger Thiele",

note = "Publisher Copyright: {\textcopyright} 2025 American College of Cardiology Foundation",

year = "2025",

month = oct,

doi = "10.1016/j.jchf.2025.102578",

language = "English",

volume = "13",

journal = "JACC: Heart Failure",

issn = "2213-1779",

publisher = "Elsevier Inc.",

number = "10",

}

TY - JOUR

T1 - Inferior Vena Cava Ultrasound to Guide Decongestion in Acute Decompensated Heart Failure

T2 - A Randomized Controlled Trial

AU - CAVA-ADHF-DZHK10 Investigators

AU - Jobs, Alexander

AU - Rausch, Tanja K.

AU - König, Inke R.

AU - Vonthein, Reinhard

AU - Devendra, Ashika

AU - Schäfer, Jane

AU - Nauck, Matthias

AU - Eitel, Ingo

AU - Stiermaier, Thomas

AU - Laugwitz, Karl Ludwig

AU - Ledwoch, Jakob

AU - Valentova, Miroslava

AU - von Haehling, Stephan

AU - Störk, Stefan

AU - Arnold, Natalie

AU - Karakas, Mahir

AU - Westermann, Dirk

AU - Lenz, Tobias

AU - Gori, Tommaso

AU - Edelmann, Frank

AU - Seppelt, Philipp

AU - Felix, Stephan B.

AU - Lutz, Matthias

AU - Hedwig, Felix

AU - Akin, Ibrahim

AU - Scherer, Clemens

AU - Desch, Steffen

AU - Thiele, Holger

PY - 2025/10

Y1 - 2025/10

N2 - Background: Residual congestion at hospital discharge after an episode of acute decompensated heart failure (ADHF) is associated with poor prognosis. There is no consensus on how optimal decongestion should be assessed. Objectives: This study aims to determine whether decongestive therapy guided by ultrasound measurements of inferior vena cava (IVC) diameters leads to greater reductions in N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels from baseline to hospital discharge as compared with decongestion treatment guided by clinical assessment alone. Methods: In a randomized controlled multicenter trial, patients admitted for ADHF (NYHA functional class ≥III) exhibiting signs of pulmonary congestion, peripheral edema, and NT-proBNP levels >300 ng/L were randomized to either decongestion therapy guided by daily IVC ultrasound plus clinical assessment or clinical assessment alone. The primary endpoint was the change in NT-proBNP levels from baseline to discharge. Results: A total of 388 patients were randomized, of which 327 were included in the primary intention-to-treat analysis. The between-group difference in primary endpoint of change in NT-proBNP levels was 5.4% (95% CI: −9.4% to 22.6%; P = 0.58). Safety events were numerically less frequent in the IVC ultrasound–guided group. No difference between groups was consistently observed in secondary endpoints with similar rates of hemoconcentration and intensity of diuretic treatment. Conclusions: Additional ultrasound evaluation of IVC diameters did not improve decongestion treatment compared with clinical assessment alone among patients admitted for ADHF. (Ultrasound Evaluation of the IVC in Addition to Clinical Assessment to Guide Decongestion in ADHF [CAVA-ADHF-DZHK10]; NCT03140566).

AB - Background: Residual congestion at hospital discharge after an episode of acute decompensated heart failure (ADHF) is associated with poor prognosis. There is no consensus on how optimal decongestion should be assessed. Objectives: This study aims to determine whether decongestive therapy guided by ultrasound measurements of inferior vena cava (IVC) diameters leads to greater reductions in N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels from baseline to hospital discharge as compared with decongestion treatment guided by clinical assessment alone. Methods: In a randomized controlled multicenter trial, patients admitted for ADHF (NYHA functional class ≥III) exhibiting signs of pulmonary congestion, peripheral edema, and NT-proBNP levels >300 ng/L were randomized to either decongestion therapy guided by daily IVC ultrasound plus clinical assessment or clinical assessment alone. The primary endpoint was the change in NT-proBNP levels from baseline to discharge. Results: A total of 388 patients were randomized, of which 327 were included in the primary intention-to-treat analysis. The between-group difference in primary endpoint of change in NT-proBNP levels was 5.4% (95% CI: −9.4% to 22.6%; P = 0.58). Safety events were numerically less frequent in the IVC ultrasound–guided group. No difference between groups was consistently observed in secondary endpoints with similar rates of hemoconcentration and intensity of diuretic treatment. Conclusions: Additional ultrasound evaluation of IVC diameters did not improve decongestion treatment compared with clinical assessment alone among patients admitted for ADHF. (Ultrasound Evaluation of the IVC in Addition to Clinical Assessment to Guide Decongestion in ADHF [CAVA-ADHF-DZHK10]; NCT03140566).

UR - https://www.scopus.com/pages/publications/105015319449

U2 - 10.1016/j.jchf.2025.102578

DO - 10.1016/j.jchf.2025.102578

M3 - Journal articles

C2 - 40929999

AN - SCOPUS:105015319449

SN - 2213-1779

VL - 13

JO - JACC: Heart Failure

JF - JACC: Heart Failure

IS - 10

M1 - 102578

ER -

Inferior Vena Cava Ultrasound to Guide Decongestion in Acute Decompensated Heart Failure: A Randomized Controlled Trial

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