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Current diagnosis of heart failure (HF) is vague and impractical. There are conflicting opinions between clinicians on the criteria for diagnosis of HF or the status of HF (compensated or decompensated). A new classification of HF and assessment of the status of HF are based on the condition of fluid in 3 compartments of the body. The intravascular part includes the intra-arterial and intravenous compartments. The extravascular compartment is mainly extracellular fluid in the tissue. Well compensated HF happens when the capacitance of the intravascular compartment is not overwhelmed. So we suggest a new test to confirm the status of fluid in the intravascular system mainly the venous system for patient with well compensated HF.
Patients with dilated cardiomyopathy and low ejection fraction (EF) were enrolled and treated optimally. At the end, patient was considered improved and their HF status is well compensated. These patients were examined for fluid overload in the venous system, mainly by the presence of rales in the lung and by painful sensation with a minimal punch in the right lower rib cage. Fluid overload in the extravascular system is defined as fluid infiltration in the abdominal wall, edema at the ankle, thigh, dependent areas. The study group underwent the new Expansibility of the Femoral Vein (EFV) and had treatment based on its results. The EFV is the ultrasound study of the femoral vein examining its size and expansibility during strong cough. In general, the location of the femoral artery and vein to be checked is the sagittal 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 femoral artery. If the size of the femoral vein during cough is 3 times larger than the one at baseline, the test is considered normal. If the size of the femoral vein is >3 times larger than then baseline, it is considered abnormal suggesting excessive venous pooling. If the femoral vein expands only <2 times of the baseline during cough, it is considered abnormal suggesting present or future pulmonary hypertension. If this test was done in conjunction with a right heart catheterization, then the femoral vein pressure at baseline and during cough is recorded. The Group A: The patients were assessed based on conventional physical examination. Group B: the patients were diagnosed with the new expansibility of the femoral vein (EFV) test.
50 patients were enrolled from January 2015 to April 2016. All came with the diagnosis of acute on chronic systolic HF (or decompensated HF). All the patients had echo which showed dilated cardiomyopathy with low EF (mean EF= 36%). At the end of the treatment period, the patients were considered improved with compensated HF. By physical examination, the majority of patient had NO intravascular fluid overload. However, by the EFV test, only 60% patients had smaller size of the femoral vein and the femoral vein could expand again with cough. The EFV test was shown to be more accurate than physical exam for confirming the compensated status of HF.
With treatment, the patients with decompensated HF improved and were upgraded to “compensated”. However the EFV test showed only 60 % of these patients truly achieved normal size of the femoral vein which also was able to expand its size upon cough. EFV was more accurate in confirming that the HF is now compensated.