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Ivey-Miranda JB, Wetterling F, Gaul R, et al. Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone. Eur J Heart Fail. 2021;doi: 10.1002/ejhf.2395.
Ivey-Miranda, J. B., Wetterling, F., Gaul, R., Sheridan, S., Asher, J. L., Rao, V. S., Maulion, C., Mahoney, D., Mebazaa, A., Gray, A. P., Burkhoff, D., Cowie, M. R., Cox, Z. L., Butler, J., Fudim, M., McDonald, K., Damman, K., Borlaug, B. A., & Testani, J. M. (2021). Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone. European journal of heart failure, . https://doi.org/10.1002/ejhf.2395
Ivey-Miranda, Juan B, et al. "Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone." European journal of heart failure vol. (2021). doi: https://doi.org/10.1002/ejhf.2395
Ivey-Miranda JB, Wetterling F, Gaul R, Sheridan S, Asher JL, Rao VS, Maulion C, Mahoney D, Mebazaa A, Gray AP, Burkhoff D, Cowie MR, Cox ZL, Butler J, Fudim M, McDonald K, Damman K, Borlaug BA, Testani JM. Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone. Eur J Heart Fail. 2021 Nov 27; doi: 10.1002/ejhf.2395. Epub 2021 Nov 27. PMID: 34837447.
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Eur J Heart Fail. 2021 Nov 27; doi: 10.1002/ejhf.2395. Epub 2021 Nov 27.

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

European journal of heart failure

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

Affiliations

  1. Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT, USA.
  2. Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
  3. FIRE1, Dublin, Ireland.
  4. Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA.
  5. Université de Paris, Inserm 942 MASCOT, Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, APHP Nord, Paris, France.
  6. Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  7. Cardiovascular Research Foundation, New York, NY, USA.
  8. School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
  9. Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA.
  10. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
  11. Duke Clinical Research Institute, Durham, NC, USA.
  12. Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
  13. University College Dublin, Dublin, Ireland.
  14. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
  15. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
  16. Translational Catalyst, LLC, Guilford, CT, USA.

PMID: 34837447 DOI: 10.1002/ejhf.2395

Abstract

AIMS: Remote monitoring of pulmonary artery pressure has reduced heart failure (HF) hospitalizations in chronic HF as elevation of pulmonary artery pressure provides information that can guide treatment. The venous system is characterized by high capacitance, thus substantial increases in intravascular volume can occur before filling pressures increase. The inferior vena cava (IVC) is a highly compliant venous conduit and thus a candidate for early detection of change in intravascular volume. We aimed to compare IVC cross-sectional area using a novel sensor with cardiac filling pressures during experimental manipulation of volume status, vascular tone, and cardiac function.

METHODS AND RESULTS: Experiments were conducted in sheep to manipulate volume status (colloid infusion), vascular tone (nitroglycerin infusion) and cardiac function (rapid cardiac pacing). A wireless implantable IVC sensor was validated ex-vivo and in-vivo, and then used to measure the cross-sectional area of the IVC. Right- and left-sided cardiac filling pressures were obtained via right heart catheterization. The IVC sensor provided highly accurate and precise measurements of cross-sectional area in ex-vivo and in-vivo validation. IVC area changes were more sensitive than the corresponding changes in cardiac filling pressures during colloid infusion (p < 0.001), vasodilatation (p < 0.001) and cardiac dysfunction induced by rapid pacing (p ≤ 0.02).

CONCLUSIONS: Inferior vena cava area can be remotely and accurately measured in real time with a wireless implantable sensor. Changes in IVC area are more sensitive than corresponding changes in filling pressures following experimental volume loading and fluid redistribution. Additional research is warranted to understand if remote monitoring of the IVC may have advantages over pressure-based monitors in HF.

© 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Keywords: Animal; Heart failure; Inferior vena cava; Models; Venous pressure

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