Ultrasonographic Optic Nerve Sheath Diameter as a Non-Invasive Marker of Systemic Congestion in Decompensated Heart Failure

Background: Assessing fluid status in decompensated heart failure (DHF) is challenging. This study evaluates ultrasonographic optic nerve sheath diameter (ONSD), a non-invasive technique, as a marker for systemic venous congestion.
Objective: To assess the value of ONSD and its relationship with other clinical and sonographic markers of congestion in DHF patients.
Patients and Methods: This cross-sectional study included sixty patients with DHF who underwent comprehensive point-of-care ultrasound (ocular, cardiac, lung, IVC) and clinical evaluation, including central venous pressure (CVP) measurement.
Results: Enlarged ONSD was highly prevalent (96.7%) and demonstrated a strong, direct relationship with invasively measured CVP (r=0.797, p < 0.001). ONSD size also correlated significantly with sonographic and clinical signs of systemic fluid overload, including lung congestion (LUS score, r=0.938), a dilated IVC (r=0.871), and cardiac function (EF%, r=-0.692).
Conclusion: Ultrasonographic ONSD measurement is a simple, reliable, non-invasive marker of systemic congestion in DHF. It serves as a powerful tool to complement a multi-organ ultrasound approach to patient care.