Blood Volume Analysis: A New Technique and New Clinical Interest Reinvigorate a Classic Study

Manzone, Timothy; Dam, Hung; Soltis, Daniel; Sagar, Vidya V.

doi:10.2967/jnmt.106.035972

Cited by 65 publications

(45 citation statements)

References 18 publications

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“…Trends in these variables may allow the early detection of HF decompensation. Transcutaneous thoracic impedance 18 and blood volume analysis 19 can assess instantaneous volume status in chronic HF. These methods can be time-consuming and require a healthcare visit.…”

Section: Discussionmentioning

confidence: 99%

Direct Left Atrial Pressure Monitoring in Ambulatory Heart Failure Patients

et al. 2007

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Background-We describe the first human experience with a permanently implantable, direct left atrial pressure (LAP) monitoring system in ambulatory patients with chronic heart failure. Methods and Results-Eight patients with established heart failure and at least 1 heart failure hospitalization or unplanned visit for parenteral therapy in the last year underwent device implantation under fluoroscopic guidance. All subjects received aspirin 150 mg and clopidogrel 75 mg daily. Subjects measured LAP twice daily and attended a clinic regularly for data upload and device calibration. Right heart catheterization was performed at the time of device implantation and at 12 weeks. The device was implanted in all subjects with no procedural complications. At the 12-week follow-up, 87% of device LAP measurements were within Ϯ5 mm Hg of simultaneous pulmonary capillary wedge pressure readings over a wide range of pressures (1.6 to 71 mm Hg). Net drift corrected by calibration was Ϫ0.2Ϯ1.9 mm Hg/mo. During short-term follow-up, there were no device-related complications or systemic emboli. There were no deaths, no unplanned heart failure clinic visits, and no admissions for heart failure. Conclusions-Ambulatory monitoring of direct LAP with a new implantable device was well tolerated, feasible, and accurate at a short-term follow-up. Further follow-up and investigation are warranted to evaluate the clinical utility of LAP monitoring in patients with heart failure.

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Section: Discussionmentioning

confidence: 99%

Direct Left Atrial Pressure Monitoring in Ambulatory Heart Failure Patients

et al. 2007

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“…These studies have identified many areas where measurement of PV and BV would be clinically useful including congestive HF [21, 23-26], sepsis [27], and surgical patients [28]. Research radioisotope measurements, using the indicator dilution technique have traditionally been considered the gold standard for BV and PV assessment [22, 29-32], but they are cumbersome and expensive, especially at the bedside. An FDA-approved BV measurement system (Daxor, BVA-100) has commercialized the RISA technique and utilized comparisons to the ideal BV weight method [33].…”

Section: Discussionmentioning

confidence: 99%

A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume

Molitoris¹,

George²,

Murray³

et al. 2019

Cardiorenal Med

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Objectives: To determine the performance of a rapid fluorescent indicator technique for measuring plasma volume (PV). Methods: This was an open-label, observational evaluation of a two-component intravenous visible fluorescent dye technique to rapidly measure PV in 16 healthy subjects and 16 subjects with chronic kidney disease (8 stage 3 and 8 stage 4 CKD), at 2 clinical research sites. The method consisted of a single intravenous injection of 12 mg of a large 150-kDa carboxy-methyl dextran conjugated to a fluorescent rhodamine-derived dye as the PV marker (PVM), and 35 mg of a small 5-kDa carboxy-methyl dextran conjugated to fluorescein, the renal clearance marker. Dye concentrations were quantified 15 min after the injections for initial PV measurements using the indicator-dilution principle. Additional samples were taken over 8 h to evaluate the stability of the PVM as a determinant of PV. Blood volumes (BV) were calculated based on PV and the subject’s hematocrit. Pharmacokinetic parameters were calculated from the plasma concentration data taken over several days using noncompartmental methods (Phoenix WinNonlin®). Linear correlation and Bland-Altman plots were used to compare visible fluorescent injectate-measured PV compared to Nadler’s formula for estimating PV. Finally, 8 healthy subjects received 350 mL infusion of a 5% albumin solution in normal saline over 30 min and a repeat PV determination was then carried out. Results: PV and BV varied according to weight and body surface area, with PV ranging from 2,115 to 6,234 mL and 28.6 to 41.9 mL/kg when weight adjusted. Both parameters were stable for > 6 h with repeated plasma measurements of the PVM. There was no difference between healthy subjects and CKD subjects. Overall, there was general agreement with Nadler’s estimation formula for the mean PV in subjects. A 24-h repeat dose measurement in 8 healthy subjects showed PV variability of 98 ± 121 mL (mean = 3.8%). Additionally, following an intravenous bolus of 350 mL of a 5% albumin solution in normal saline in 8 healthy subjects, the mean (SD) measured increase in PV was 356 (±50.0) mL post-infusion. There were no serious adverse events reported during the study. Conclusions: This minimally invasive fluorescent dye approach safely allowed for rapid, accurate, and reproducible determination of PV, BV, and dynamic monitoring of changes following fluid administration.

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“…A semi-automated blood volume analyzer, the BVA-100, also uses indicator dilution principles to measure plasma volume using radioactive iodinated human serum albumin. Although the BVA-100 system improves accuracy and eliminates the many time-consuming and difficult steps required for on-site standard testing, it is expensive, and is not suitable for repeated measurement of CBV [5,6].…”

mentioning

confidence: 99%

“…The indicator dilution technique using radioactive tracers has been used in nuclear medicine departments for over 50 years to monitor CBV in patients with pheochromocytoma [5]. A semi-automated blood volume analyzer, the BVA-100, also uses indicator dilution principles to measure plasma volume using radioactive iodinated human serum albumin.…”

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confidence: 99%

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Perioperative sequential monitoring of hemodynamic parameters in patients with pheochromocytoma using the Non-Invasive Cardiac System (NICaS)

et al. 2014

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Pheochromocytoma is a catecholaminesecreting tumor arising from the adrenal medulla or extra-adrenal paraganglia [1]. Surgical excision of the tumor is the only curative therapy. However, surgery carries a high risk of inducing a massive release of catecholamines into the circulation, leading to hypertensive crisis, cardiac arrhythmia, pulmonary edema, and cardiac ischemia. Prolonged peripheral vasoconstriction secondary to high catecholamine levels results in volume depletion [2], and acute reduction in catePerioperative sequential monitoring of hemodynamic parameters in patients with pheochromocytoma using the Non-Invasive Cardiac System (NICaS) abstract. Surgical treatment of pheochromocytoma is associated with a high risk of hemodynamic instability. To reduce the risk of perioperative complications, adequate medical treatment to normalize blood pressure and restore blood volume is required. Accurate evaluation of the circulating blood volume (CBV) in perioperative patients with pheochromocytoma is clinically important. In the present study, we adopted whole-body bioimpedance monitoring technique using the NonInvasive Cardiac System (NICaS), which can non-invasively measure cardiac output (CO) values. NICaS-derived CO values were evaluated in eight preoperative patients with pheochromocytoma and were compared with simultaneous CBV values measured by a conventional indicator dilution method using 131 I-labeled human serum albumin. In these patients with pheochromocytoma, the NICaS-derived CO values were significantly correlated with the CBV values measured by 131 I-labeled human serum albumin (4.86 ± 1.05 L/min vs 4.79 ± 1.02 L; r = 0.906; P = 0.002). Sequential NICaS-derived CO values confirmed that CBV increased after preoperative treatment with an α-blocker, with or without volume loading. The results of this study indicate that NICaS can be used to accurately and non-invasively evaluate the hemodynamic status. By sequential monitoring of NICaS-derived CO values, we are able to confirm whether adequate CBV in a patient with pheochromocytoma is obtained by preoperative medical treatment with α-blockers or volume loading, to avoid perioperative complications.Key words: Pheochromocytoma, Cardiac output (CO), NICaS, Circulating blood volume, α-blocker cholamine levels after pheochromocytoma surgery can cause hypotension and shock [3]. To minimize the perioperative complications, patients are treated with α-blockers and intravenous fluids to restore the circulating blood volume (CBV) before surgery [2][3][4].The indicator dilution technique using radioactive tracers has been used in nuclear medicine departments for over 50 years to monitor CBV in patients with pheochromocytoma [5]. A semi-automated blood volume analyzer, the BVA-100, also uses indicator dilution principles to measure plasma volume using radioactive iodinated human serum albumin. Although the BVA-100 system improves accuracy and eliminates the many time-consuming and difficult steps required for on-site standard testing, it is expensive, and is n...

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Blood Volume Analysis: A New Technique and New Clinical Interest Reinvigorate a Classic Study

Cited by 65 publications

References 18 publications

Direct Left Atrial Pressure Monitoring in Ambulatory Heart Failure Patients

Direct Left Atrial Pressure Monitoring in Ambulatory Heart Failure Patients

A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume

Perioperative sequential monitoring of hemodynamic parameters in patients with pheochromocytoma using the Non-Invasive Cardiac System (NICaS)

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