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Non-invasive Venous Waveform Analysis (NIVA) estimates static volume

Session Poster Session 4

Speaker Monica Polcz

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Multidisciplinary Interventions
  • Session type : Poster Session

Authors : M Polcz (Nashville,US), P Liesy (Nashville,US), J Lindenfeld (Nashville,US), K Hocking (Nashville,US), C Brophy (Nashville,US), B Alvis (Nashville,US)

Authors:
M Polcz1 , P Liesy1 , J Lindenfeld1 , K Hocking1 , C Brophy1 , B Alvis1 , 1Vanderbilt University - Nashville - United States of America ,

Citation:

Background/Introduction: Volume overload in patients with congestive heart failure (CHF) leads to symptomatic edema and pulmonary congestion, resulting in decreased quality of life and frequent hospital admissions. Clinical signs of volume overload including weight gain, edema grade, and shortness of breath occur late and are not reliable indicators of volume overload. Medical devices for outpatient volume assessment to prevent readmission includes impedance devices such as ZOE (NonInvasive Medical Technologies) but have failed to gain widespread use. Non-Invasive Venous waveform Analysis (NIVA) is a novel technology that captures the peripheral venous waveform with a wristband containing a piezoelectric sensor, allowing analysis of waveform changes that occur at different volume states.

Purpose: This is a proof-of-concept study demonstrating the use of NIVA for estimation of static volume status by correlation with an existing approved non-invasive device, the ZOE impedance monitor and with pulmonary capillary wedge pressure (PCWP), the current gold standard.

Methods: The NIVA device was attached to the volar aspect of the wrist overlying the venous plexus and signals obtained for at least three minutes. The power magnitude of the fundamental pulse frequency (f0) and weighted magnitudes of harmonics of the pulse frequency (f1-7) were used to generate a preliminary proprietary algorithm to derive a NIVA Value. The ZOE device was applied as per manufacturer’s instructions and the average of three consecutive measurements used for analysis. PCWP was performed at end expiration by an experienced interventional cardiologist. All measurements were obtained within one hour of right heart catheterization.

Results: With increased fluid, thoracic impedance decreases hence ZOE measurements correlate inversely with volume.  NIVA Values correlated inversely with ZOE measurements (r= -0.80, n=29, p < 0.05). PCWP ranged from 4 to 27 mmHg, with a mean of 14.4 mmHg. NIVA correlated significantly with PCWP (r=0.75, n=73, p<0.05).

Conclusions: NIVA correlates with existing thoracic impedance technology (ZOE) and with the gold standard PCWP. NIVA represents a new technology that utilizes a novel physiologic signal, the peripheral venous waveform, to provide an estimation of static volume status for guidance of outpatient treatment in patients with CHF.

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