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NEW TEST TO PREDICT WHICH HEART FAILURE PATIENTS WILL HAVE BUN AND CREATININE INCREASED BY DIURETICS Thach Nguyen, Dinh Quang Minh Tri...  Group 2: the new Size and Expansion of the

NEW TEST TO PREDICT WHICH

HEART FAILURE PATIENTS

WILL HAVE BUN AND CREATININE INCREASED BY

DIURETICS

Thach Nguyen, Dinh Quang Minh Tri

BACKGROUND

 Current management of heart failure (HF) includes intravenous or oral diuretic

 In many cases, diuretics caused severe increase of blood urea nitrogen (BUN) or creatinine level

=> Discontinuation of diuretics or even resumption

of IV fluid

QUESTIONS

How to predict which HF patient will develop increase of BUN and creatinine or renal failure with diuretic?

Methods

 Group 1: conventional treatment

 Group 2: the new Size and Expansion of the Femoral Vein (SEFV) of which the results were shown to the investigators

Methods

Principles on the Size and Expansion of the Femoral

Vein (SEFV) test

The first principle:

 The volume of blood going through the femoral artery

= returning through the common femoral vein

 The size of the femoral artery = the femoral vein

 The amount of venous return is lower => edema in the lower leg

Methods

Principles on the Size and Expansion of the Femoral

Vein (SEFV) test The second principle:

The size of the femoral vein can change from the same size to the femoral artery or to be bigger depending on the amount of blood in the intravascular compartment

=> Fairly accurate method to assess the arterial and

venous volume could be achieved

Methods New Non-Invasive SEFV Test

 Examinaton the size of the femoral vein and its expansion with cough

 Check in the coronal plane immediately

proximal to the bifurcation of the superficial and deep femoral artery

 The size of the femoral vein is a little larger than the size of the common femoral artery

Methods New Non-Invasive SEFV Test

Figure 1

Methods New Non-Invasive SEFV Test

Figure 2

Methods New Non-Invasive SEFV Test

Figure 3

Results

 25 patients with acute on chronic systolic HF - December

2015 to May 2016

 20/25 patients had abnormal SEFV test

 18/20 of these patients did not have increase BUN or

creatinine

 One patient had small femoral vein and only 20mg of

furosemide brought his creatinine from 0.9mg to 2.0mg overnight

Conclusions

The patients with HF should have the SEFV early and its results helped to guide the use of diuretics without causing renal failure

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