Author + information
- Thach Nguyen1,2,3,
- Khanh Duong3,
- Bui Pham Thai Hoa2,
- Nguyen Minh Tri Nhan2,
- Le Thi Thuy Linh2 and
- Gianluca Rigatelli4
At the present time, criteria for diagnosis of left ventricular (LV) dysfunction are non-specific. A measurement of left ventricular end diastolic pressure (LVEDP) > 24mmHg or a pulmonary capillary wedge pressure (PCWP) > 24 mmHg is considered LV dysfunction. These measurements require invasive procedure and cannot be repeated frequently. How can we measure the PCWP non-invasively?
Patients arrived to the cardiac catheterization laboratories for right and left heart catheterization were enrolled. The indications for procedures were aortic stenosis, LV dysfunction or pulmonary hypertension. All patients underwent the ultrasound test to measure the size and expansibility of the femoral vein (FV) (SEFV) at baseline and upon 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 intravascular compartment. Then the patient was asked to cough in order to measure the size of the FV. Patient underwent right heart catheterization as usual. The LVEDP and PCWP and PAM were measured and correlated with the size of the FV and the expansion of the FV upon cough.
20 patients were enrolled. If there was only enlargement of the FV, the LVEDP was between 20-24mmHg. If the FV was enlarged > 2 times the size of the FA and there was no enlargement of the FV with cough, then the LVEDP> 24mmHg (90 % sensitivity) and (80% specificity).
The SEFV test was accurate in confirming the presence of elevated LVEDP and PAM (pulmonary HTN). The diagnosis was based on the significant fluid overload in the venous system where the majority of the blood is circulating.