Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone

Ivey‐Miranda, Juan Betuel; Wetterling, Friedrich; Gaul, Robert; Sheridan, Stephen William; Asher, Jennifer L; Rao, Veena S.; Maulion, Christopher; Mahoney, Devin; Mebazaa, Alexandre; Gray, Alastair; Burkhoff, Daniel; Cowie, Martin R.; Cox, Zachary L.; Butler, Javed; Fudim, Marat; McDonald, Kenneth; Damman, Kevin; Borlaug, Barry A.; Testani, Jeffrey M.

doi:10.1002/ejhf.2395

Cited by 18 publications

(21 citation statements)

References 26 publications

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“…In line with this physiology, filling pressures such as central venous pressure and pulmonary capillary wedge pressure have repeatedly demonstrated limited correlation with measures of volume status such as circulating blood volume and haemodynamic response to fluid challenge 19,21–30 . Additionally, the current findings are consistent with a recent study showing greater sensitivity of area measurements compared to pressure measurements in acute tests in which volume and vascular tone were manipulated 15 …”

Section: Discussionsupporting

confidence: 81%

Safety and performance of a novel implantable sensor in the inferior vena cava under acute and chronic intravascular volume modulation

Sheridan¹,

Wetterling²,

Testani

et al. 2023

European J of Heart Fail

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Aims The management of congestion is one of the key treatment targets in heart failure. Assessing congestion is, however, difficult. The purpose of this study was to investigate the safety and dynamic response of a novel, passive, inferior vena cava (IVC) sensor in a chronic ovine model. Methods and results A total of 20 sheep divided into three groups were studied in acute and chronic in vivo settings. Group I and Group II included 14 sheep in total with 12 sheep receiving the sensor and two sheep receiving a control device (IVC filter). Group III included an additional six animals for studying responses to volume challenges via infusion of blood and saline solutions. Deployment was 100% successful with all devices implanted; performing as expected with no device‐related complications and signals were received at all observations. At similar volume states no significant differences in IVC area normalized to absolute area range were measured (55 ± 17% on day 0 and 62 ± 12% on day 120, p = 0.51). Chronically, the sensors were completely integrated with a thin, reendothelialized neointima with no loss of sensitivity to infused volume. Normalized IVC area changed significantly from 25 ± 17% to 43 ± 11% (p = 0.007) with 300 ml infused. In contrast, right atrial pressure required 1200 ml of infused volume prior to a statistically significant change from 3.1 ± 2.6 mmHg to 7.5 ± 2.0 mmHg (p = 0.02). Conclusion In conclusion, IVC area can be measured remotely in real‐time using a safe, accurate, wireless, and chronic implantable sensor promising to detect congestion with higher sensitivity than filling pressures.

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Section: Discussionsupporting

confidence: 81%

Safety and performance of a novel implantable sensor in the inferior vena cava under acute and chronic intravascular volume modulation

Sheridan¹,

Wetterling²,

Testani

et al. 2023

European J of Heart Fail

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“…Devices implanted in the atrial septum to measure left atrial pressure are being investigated [ 66 ]. Monitoring venous capacity by ultrasound or other means might be an even better approach to detect and correct haemodynamic problems (both under- and over-filling) than measuring PAP [ 67 , 68 ].…”

Section: Discussionmentioning

confidence: 99%

Implanted haemodynamic telemonitoring devices to guide management of heart failure: a review and meta-analysis of randomised trials

et al. 2022

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Background and aims Congestion is a key driver of morbidity and mortality in heart failure. Implanted haemodynamic monitoring devices might allow early identification and management of congestion. Here, we provide a state-of-the-art review of implanted haemodynamic monitoring devices for patients with heart failure, including a meta-analysis of randomised trials. Methods and results We did a systematic search for pre-print and published trials in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) on the 22nd of September 2021. We included randomised trials that compared management with or without information from implanted haemodynamic monitoring devices for patients with heart failure. Outcomes selected were hospitalisation for heart failure and all-cause mortality. Changes in treatment associated with haemodynamic monitoring resulted in only a small reduction in mean pulmonary artery pressure (typically < 1 mmHg as a daily average), which generally remained much greater than 20 mmHg. Haemodynamic monitoring reduced hospitalisations for heart failure (HR 0.75; 95% CI 0.58–0.96; p = 0.03) but not mortality (RR 0.92; 95% CI 0.68–1.26; p = 0.48). Conclusions Haemodynamic monitoring for patients with heart failure may reduce the risk of hospitalization for heart failure but this has not yet translated into a reduction in mortality, perhaps because the duration of trials was too short or the reduction in pulmonary artery pressure was not sufficiently large. The efficacy and safety of aiming for larger reductions in pulmonary artery pressure should be explored. Graphical abstract

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“…In an experimental model, an implantable wireless IVC sensor provided accurate measurements of IVC area changes. Furthermore, changes in IVC area were more sensitive than changes in filling pressures for the detection of volume loading and fluid redistribution during provocative manoeuvres 10 …”

Section: Assessment Of Congestionmentioning

confidence: 98%

March 2022 at a glance: focus on medical therapy, prevention and comorbidities

Tomasoni

Adamo

Metra

2022

European J of Heart Fail

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Prevention of heart failure (HF) has been recently reviewed. 1 Banerjee et al. 2 performed a systematic analysis of randomized controlled trials (RCTs) and observational studies to identify risk factors for HF. Among 92 risk factors analysed, hypertension, stable and unstable angina, myocardial infarction, diabetes, smoking and obesity as well as atrial arrhythmias, cancer and heavy alcohol intake, though not supported by RCTs, were associated with a higher rate of incident HF. In the 5 years prior to HF diagnosis, 44.3% of patients had ≥4 risk factors. These data are consistent with recent studies focused on risk factors for HF. 1,3,4 Assessment of left atrial (LA) function has a major role in the management of HF patients. 5,6 A recent study investigated echocardiographic parameters related to LA function and their predictive value for incident HF in a large general population, without atrial fibrillation or significant valvular heart disease (VHD) at baseline. Out of 1951 participants, 187 (10%) developed HF. After multivariable adjustment, only the minimum LA volume indexed to body surface area was found to be an independent predictor of incident HF. 7 CardiomyopathiesCardiomyopathies represent a heterogeneous group of cardiac diseases causing HF. 22,23 Appropriate aetiological characterization might improve treatment strategies and prognosis. 22,24 In this issue, a position paper from the Heart Failure Association (HFA) and the Working Group on Myocardial Function of the European Society

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Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone

Cited by 18 publications

References 26 publications

Safety and performance of a novel implantable sensor in the inferior vena cava under acute and chronic intravascular volume modulation

Safety and performance of a novel implantable sensor in the inferior vena cava under acute and chronic intravascular volume modulation

Implanted haemodynamic telemonitoring devices to guide management of heart failure: a review and meta-analysis of randomised trials

March 2022 at a glance: focus on medical therapy, prevention and comorbidities

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