Author + information
- Thach Nguyen1,2,3,
- Khanh Duong3,
- Luong Ngoc Tuyet Nhi2,
- Nguyen Minh Tri Nhan2,
- Luong Thanh Phuoc2 and
- Gianluca Rigatelli2
At the present time, there is no criterion to estimate the optimal treatment for heart failure (HF) with preserved ejection fraction (HFpEF). In the past, our group suggested the criteria for diagnosis of HFpEF with normal EF and fluid overload using the size of the femoral vein (FV), measured by ultrasound. Since then, when the patients with HF were treated, we used the size of the femoral vein as a criteria of fluid overload or euvolemic status. Is this criterion the best to mark the optimal treatment of HFpEF?
Patients with HFpEF were enrolled. All patients had echocardiography to confirm EF>50% and also underwent the ultrasound test to assess the size and expansibility of the femoral vein (SEFV). The SEFV is the ultrasound study of femoral vein (FV) examining its size and expansibility with cough. The location of the femoral artery (FA) and FV to be checked is the coronal plane immediately proximal to the bifurcation of the superficial and deep femoral artery. The normal size of FV is a little larger than of the FA. If the size of the FV is twice larger than the FA, the patient has fluid overload in the venous compartment. Then the patient was asked to cough in order to measure the size of the FV. During the 2 years of treatment, the patients were followed up with physical examination in the office (including weight) and had the SEFV at regular 6 month intervals. Patients also underwent right heart catheterization to measure to the pulmonary capillary wedge pressure (PCWP).
20 patients were enrolled. All patients did well if the patients followed the strict low Na diet and <2000cc of fluid restriction. After about 6 months, the size of the FV was within normal range. The PCWP became lower than 24mmHg. There was significant lower weight. However, the sign which guaranteed a stable condition without remission of HF was the loss of cutaneous venous volume as seen on the face of the patients.
With the SEFV test, we could accurately confirm the presence of fluid overload in patients with HFpEF. However, in the treatment and follow-up the loss of cutaneous venous volume was a better marker of the euvolemic status of the patients with HFpEF. Further randomized trials are needed to confirm the above preliminary results.