Nghiệm pháp để xác định đợt mất bù cấp của suy tim mạn tính

New Non-invasive Test to Assess the Blood Volume in Health and Disease Dr Thach Nguyen, Bui Mai Thuy Tien Why should we need new method? •Syncope: diagnosed by history • Heart failure (HF) : non-specific physical findings non-pathognomonic •Clinical confounders: COPD, hepatic cirrhosis , dehydration, chronic kidney disease (CKD) Need specific test to: Diagnosing HF/cardiovascular dysfunction Guiding management of HF Which patients can be enrolled? • History: syncope, orthostatic hypotension or HF on top of COPD, chronic kidney disease (CKD) •Control group: standard testing and treatment for HF •Study group: measuring femoral vein’s size at baseline during cough SEFV TEST’S PRINCIPLES SEFV test: the Size and Expansion of the Femoral Vein test The first principle: Blood volume of femoral artery and common femoral vein: same Normal condition, size of the femoral artery and the femoral vein: same If venous return is lower =>edema in lower leg SEFV TEST’S PRINCIPLES The second principle: •In veins: containing most circulating blood •In arteries: Blood volume :small Size: not change much due to vascular tone =>Increasing cardiac output, increasing heart rate Changing size of femoral vein depends on blood volume in intravascular compartment WHAT IS SEFV TEST? SEFV test is • The ultrasound study examining size and expansion of common femoral vein during cough •A fairly accurate method to assess the arterial and venous volume could be achieved The ultrasound plane: coronal plane immediately proximal to bifurcation of superficial- deep femoral artery New Non-Invasive SEFV Test Bifurcation as the femoral artery divides into the superficial and deep femoral arteries In normal fluid status, the size of the femoral vein > the size of the common femoral artery New Non-Invasive SEFV Test The coronal plane of the artery: a single round structure New Non-Invasive SEFV Test Normal expansion of the femoral vein to less than times larger than the baseline (Without fluid overload or dehydration) SEFV in DISEASE •Fluid overload •Excessive venous pooling causing syncope •Venous compartment contraction due to Blood Loss, Dehydration or Pulmonary Hypertension Fluid Overload The size of the vein is more than times larger than the size of the femoral artery The vein is expanded maximally => cannot expand further with cough A patient with heart failure Excessive Venous Pooling Causing Syncope Femoral vein is >3 times larger than its baseline => abnormal suggesting excessive venous pooling causing orthostatic hypotension a Panel A Panel B Panel A The femoral vein at its baseline Panel B The femoral vein expanded to a huge volume upon cough Venous Compartment Contraction due to Blood Loss, Dehydration or Pulmonary Hypertension •Femoral vein not expand (barely filled with blood and no extra volume even with higher pressure from the lungs) with cough, patient has suboptimal venous capacity (e.g secondary to dehydration or bleeding) •In pulmonary hypertension, femoral vein not expand with cough Abnormal expansion of the femoral vein What did we find? December 2015 -> May 2016 : 25 patients having clinical diagnosis EFV Test (+) % EFV Test (-) % P value syncope, persistent orthostatic hypotension, HF on top of hepatic cirrhosis or COPD or CKD Syncope 35 65 With SEFVHypotension test, confirming the 80 diagnosis of fluid20overload in patients Orthostatic