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The first principle: Blood volume of femoral artery and common femoral vein: same.. SEFV TEST’S PRINCIPLES SEFV test: the Size and Expansion of the Femoral Vein test... SEFV test is • T

New Non-invasive Test to Assess the Blood

Volume in Health and Disease

Dr Thach Nguyen, Bui Mai Thuy Tien

•Syncope: diagnosed by history

• Heart failure (HF) : non-specific physical findings

non-pathognomonic

•Clinical confounders: COPD, hepatic cirrhosis , dehydration, chronic kidney disease (CKD)

Need specific test to:

Diagnosing HF/cardiovascular dysfunction Guiding management of HF

Why should we need new method?

•Syncope: diagnosed by history

• Heart failure (HF) : non-specific physical findings

non-pathognomonic

•Clinical confounders: COPD, hepatic cirrhosis , dehydration, chronic kidney disease (CKD)

Need specific test to:

Diagnosing HF/cardiovascular dysfunction Guiding management of HF

• History: syncope, orthostatic hypotension or HF on top of

COPD, chronic kidney disease (CKD)

•Control group: standard testing and treatment for HF

•Study group: measuring femoral vein’s size at baseline during cough

Which patients can be enrolled?

The first principle: Blood volume of femoral artery and

common femoral vein: same

Normal condition, size of the femoral artery and the

femoral vein: same

If venous return is lower =>edema in lower leg

SEFV TEST’S PRINCIPLES

SEFV test: the Size and Expansion of the Femoral Vein test

The second principle:

•In veins: containing most circulating blood

•In arteries:

Blood volume :small Size: not change much due to vascular tone

=>Increasing cardiac output, increasing heart rate

volume in intravascular compartment

SEFV TEST’S PRINCIPLES

SEFV test is

• The ultrasound study examining size and expansion

of common femoral vein during cough

•A fairly accurate method to assess the arterial and

venous volume could be achieved

The ultrasound plane: coronal plane immediately

proximal to bifurcation of superficial- deep femoral artery

WHAT IS SEFV TEST?

Bifurcation as the femoral artery divides into the superficial and deep femoral arteries

New Non-Invasive SEFV Test

In normal fluid status, the size of the femoral vein > the size of the common femoral artery

New Non-Invasive SEFV Test

The coronal plane of the artery: a single round structure

Normal expansion of the femoral vein to less than 2 times larger than the baseline

(Without fluid overload or dehydration)

New Non-Invasive SEFV Test

•Fluid overload

•Excessive venous pooling causing syncope

•Venous compartment contraction due to Blood Loss, Dehydration or Pulmonary Hypertension

SEFV in DISEASE

The size of the vein is more than 3 times larger than the size of the

femoral artery

The vein is expanded maximally => cannot expand further with cough

Fluid Overload

A patient with heart failure

a

Femoral vein is >3 times larger than its baseline => abnormal suggesting excessive venous pooling causing orthostatic

hypotension

Excessive Venous Pooling Causing Syncope

Panel A The femoral vein at its baseline Panel B The femoral vein expanded

to a huge volume upon cough

•Femoral vein not expand (barely filled with blood and no

extra volume even with higher pressure from the lungs) with cough, patient has suboptimal venous capacity (e.g

secondary to dehydration or bleeding)

•In pulmonary hypertension, femoral vein not expand with cough

Venous Compartment Contraction due to Blood Loss, Dehydration or Pulmonary

Hypertension

Abnormal expansion of the femoral vein

December 2015 -> May 2016 : 25 patients having clinical diagnosis syncope, persistent orthostatic hypotension, HF on top of hepatic

cirrhosis or COPD or CKD

With SEFV test, confirming the diagnosis of fluid overload in patients with severe non cardiac disease

What did we find?

EFV Test (+) % EFV Test (-) % P value

•Patients with complex disease, the EFV could confirm early the presence of HF and guide its treatment amid of multiple complex confounders Larger scale of clinical trial or registries of this new technique are needed

•Larger scale of clinical trial or registries of this new technique are needed

WHAT DID WE FIND?

Thanks for your listening!