Observational Study of Noninvasive Venous Waveform Analysis to Assess Intracardiac Filling Pressures During Right Heart Catheterization

Alvis, Bret; Polcz, Monica; Huston, Jessica; Hopper, T.S.; Leisy, Philip J; Mishra, Kelly; Eagle, Susan; Brophy, Colleen M.; Lindenfeld, JoAnn; Hocking, Kyle M.

doi:10.1016/j.cardfail.2019.09.009

Cited by 15 publications

(29 citation statements)

References 27 publications

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“… 1 , 2 , 6 , 7 Furthermore, a piezoelectric sensor placed on the volar aspect of the wrist, directly over the superficial veins, has also allowed for non-invasive capture of the peripheral venous waveform. 3 , 4 , 16 , 17 The piezoelectric sensor is connected to a control box that amplifies the venous waveform detected from vibrations related to the low amplitude pulsatile flow of venous blood. In addition to direct invasive and non-invasive capture of peripheral venous waveforms, indirect analysis of plethysmographic waveforms have been used to detect the peripheral venous waveform.…”

Section: Methods Of Venous Waveform Acquisitionmentioning

confidence: 99%

“… 7 NIVA, which has the benefit of using a completely non-invasive sensor for waveform acquisition, has demonstrated strong correlation with PCWP in patients undergoing right heart catheterization (r = 0.69, p < 0.05, n = 83) and is able to predict PCWP > 18 mmHg, a clinically accepted value indicating venous congestion, 28 , 29 with a sensitivity of 80% and a specificity of 53%. 4 …”

Section: Clinical Applications Of Venous Waveformsmentioning

confidence: 99%

“…Signal noise may be introduced by surgical electrocautery and patient or transducer movement. 3 , 4 , 30 , 31 Ideally, waveform recordings with motion artifact have the noise either automatically or manually removed. 14 , 30 , 31 This is usually not feasible, resulting in the large number of signals excluded from many of these studies.…”

Section: Limitations Of Venous Waveform Analysismentioning

confidence: 99%

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Physiology and clinical utility of the peripheral venous waveform

Chang

Leisy

Sobey

et al. 2020

JRSM Cardiovascular Disease

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The peripheral venous system serves as a volume reservoir due to its high compliance and can yield information on intravascular volume status. Peripheral venous waveforms can be captured by direct transduction through a peripheral catheter, non-invasive piezoelectric transduction, or gleaned from other waveforms such as the plethysmograph. Older analysis techniques relied upon pressure waveforms such as peripheral venous pressure and central venous pressure as a means of evaluating fluid responsiveness. Newer peripheral venous waveform analysis techniques exist in both the time and frequency domains, and have been applied to various clinical scenarios including hypovolemia (i.e. hemorrhage, dehydration) and volume overload.

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Section: Methods Of Venous Waveform Acquisitionmentioning

confidence: 99%

Section: Clinical Applications Of Venous Waveformsmentioning

confidence: 99%

Section: Limitations Of Venous Waveform Analysismentioning

confidence: 99%

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Physiology and clinical utility of the peripheral venous waveform

Chang

Leisy

Sobey

et al. 2020

JRSM Cardiovascular Disease

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“…With this innovative technology, the venous waveform is amplified and the lower frequencies that correspond to the pulse rate, and its harmonics (multiples of the pulse rate) are analyzed based on the ratiometric relationship of their respective amplitudes to hemodynamic volume changes. The result of said analysis is a NIVA value-an adjusted numerical value initially developed in adult patients undergoing elective right heart catheterization and considered to be "equivalent" to the clinical gold standard of volume status, pulmonary capillary wedge pressure [12,13]. A recent study in adults showed that the NIVA value correlated linearly with blood loss and with the hemodynamic indices [14].…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Venous waveform Analysis (NIVA) for volume assessment during complex cranial vault reconstruction: A proof-of-concept study in children

et al. 2020

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Background Non-Invasive Venous waveform Analysis (NIVA) is novel technology that captures and analyzes changes in venous waveforms from a piezoelectric sensor on the wrist for hemodynamic volume assessment. Complex cranial vault reconstruction is performed in children with craniosynostosis and is associated with extensive blood loss, potential life-threatening risks, and significant morbidity. In this preliminary study, we hypothesized that NIVA will provide a reliable, non-invasive, quantitative assessment of intravascular volume changes in children undergoing complex cranial vault reconstruction. Objective To present proof-of-concept results of a novel technology in the pediatric population. Methods The NIVA prototype was placed on each subject's wrist, and venous waveforms were collected intraoperatively. Estimated blood loss and fluid/blood product administration were recorded in real time. Venous waveforms were analyzed into a NIVA value and then correlated, along with mean arterial pressure (MAP), to volume changes. Concordance was quantified to determine if the direction of change in volume was similar to the direction of change in MAP or change in NIVA.

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“…An early prototype device has demonstrated the ability to identify small volumes of blood loss, volume removed during hemodialysis, and correlation with a wide range of pulmonary capillary wedge pressures (PCWP), the gold-standard estimate of left ventricular preload, in patients undergoing right heart catheterization (n ¼ 83, r ¼ 0.69, p < 0.05). [1][2][3] While there is growing evidence to support venous waveform analysis as a technique to monitor volume status, little is known as to how the venous waveform may be affected by vasoactive agents and whether this may confound analysis of volume status. The aim of this study was to determine the effect of vasoconstriction and vasodilation on non-invasively captured venous waveforms utilizing a porcine model.…”

Section: Introductionmentioning

confidence: 99%

A brief report on the effects of vasoactive agents on peripheral venous waveforms in a porcine model

Polcz

Hocking

Chang

et al. 2020

JRSM Cardiovascular Disease

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Objectives Non-invasive venous waveform analysis (NIVA) is a recently described, novel technique to assess intravascular volume status. Waveforms are captured with a piezoelectric sensor; analysis in the frequency domain allows for calculation of a “NIVA value” that represents volume status. The aim of this report was to determine the effects of vasoactive agents on the venous waveform and calculated NIVA values. Design Porcine experimental model. Setting Operating theatre. Participants A piezoelectric sensor was secured over the surgically exposed saphenous vein in eight anesthetized pigs. Main outcome measures NIVA value, pulmonary capillary wedge pressure (PCWP), and mean arterial pressure prior to and post intravenous administration of 150–180 µg of phenylephrine or 100 µg of sodium nitroprusside. Results Phenylephrine led to a decrease in NIVA value (mean 9.2 vs. 4.6, p < 0.05), while sodium nitroprusside led to an increase in NIVA value (mean 9.5 vs. 11.9, p < 0.05). Mean arterial pressure increased after phenylephrine ( p < 0.05) and decreased after sodium nitroprusside ( p < 0.05). PCWP did not change significantly after phenylephrine ( p = 0.25) or sodium nitroprusside ( p = 0.06). Conclusions Vasoactive agents lead to changes in non-invasively obtained venous waveforms in euvolemic pigs, highlighting a potential limitation in the ability to NIVA to estimate static volume in this setting. Further studies are indicated to understand the effects of vasoactive agents in the setting of hypovolemia and hypervolemia.

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Observational Study of Noninvasive Venous Waveform Analysis to Assess Intracardiac Filling Pressures During Right Heart Catheterization

Cited by 15 publications

References 27 publications

Physiology and clinical utility of the peripheral venous waveform

Physiology and clinical utility of the peripheral venous waveform

Non-Invasive Venous waveform Analysis (NIVA) for volume assessment during complex cranial vault reconstruction: A proof-of-concept study in children

A brief report on the effects of vasoactive agents on peripheral venous waveforms in a porcine model

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