Bedside ultrasound to guide diuretics in hospitalized acute heart failure

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

Hospitalized adults with acute decompensated heart failure and an RIJV distensibility index below 66% on POCUS are enrolled. Participants receive standard IV furosemide either guided by routine clinical assessment or by serial POCUS measurements of RIJV cross-sectional area and distensibility during rest and Valsalva to estimate right atrial pressure. The POCUS-guided arm uses those measurements to adjust diuretic dosing and duration with the goal of achieving better decongestion at discharge. Outcomes include 30-day readmission, rates of acute kidney injury, and degree of residual congestion at discharge.

Why it matters

Who can join: the full rules

List the inclusion criteria:

1. Age: Patients must be 18 years or older.
2. Diagnosis: Must have a confirmed diagnosis of acute decompensated heart failure (ADHF).
3. Treatment Plan: Patients must be planned for treatment with intravenous (IV) diuretics.
4. POCUS Measurement: Must have an abnormal right internal jugular vein (RIJV) distensibility index (DI) of \<66% on point-of-care ultrasound (POCUS) at the time of admission.

These criteria ensure that participants are appropriately selected for the study and are likely to benefit from POCUS-guided diuretic management.

List the exclusion criteria:

1. Left Ventricular Assist Devices (LVAD): Patients with LVADs will be excluded due to their unique hemodynamics, which may interfere with study assessments.
2. Anatomical Incompatibilities: Excludes patients with RIJV or superior vena cava thrombus, congenital heart disease, or severe tricuspid regurgitation, as these conditions may impair accurate POCUS measurements.
3. Cardiomyopathy: Patients with hypertrophic or infiltrative cardiomyopathy will be excluded.
4. End-of-Life Care: Patients receiving hospice care or comfort measures only will not be included in the study.
5. Advanced Cancer: Patients with metastatic cancer will be excluded.
6. Severe Liver Dysfunction: Patients with a MELD-Na score greater than 20, indicating severe liver dysfunction, will be excluded.
7. End stage chronic kidney disease
8. Inability to Provide Consent: Patients who are unable to provide informed consent, due to cognitive impairment or other reasons, will not be eligible.
9. Inotropic Support: Patients requiring inotropic support at the time of enrollment will be excluded, as they represent a more severe heart failure profile that may not be suitable for this trial.

Where it's running

• University of Pittsburgh Medical Center
  Pittsburgh, Pennsylvania, United States Recruiting
• UPMC Presbyterian
  Pittsburgh, Pennsylvania, United States Recruiting
• UPMC Shadyside
  Pittsburgh, Pennsylvania, United States Recruiting
• UPMC East
  Pittsburgh, Pennsylvania, United States Not yet recruiting
• UPMC Mercy
  Pittsburgh, Pennsylvania, United States Not yet recruiting

Study contacts

• Principal investigator: John J Pacella, MD — University of Pittsburgh Medical Center (UPMC)
• Study coordinator: John J Pacella, MD
• Email: pacellajj@upmc.edu
• Phone: 4127805529

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.