Abstract
Background
Outpatient monitoring and management of patients with heart failure (HF) reduces hospitalizations
and health care costs. However, the availability of noninvasive approaches to assess
congestion is limited. Noninvasive venous waveform analysis (NIVA) uses a unique physiologic
signal, the morphology of the venous waveform, to assess intracardiac filling pressures.
This study is a proof of concept analysis of the correlation between NIVA value and
pulmonary capillary wedge pressure (PCWP) and the ability of the NIVA value to predict
PCWP > 18 mmHg in subjects undergoing elective right heart catheterization (RHC).
PCWP was also compared across common clinical correlates of congestion.
Methods and Results
A prototype NIVA device, which consists of a piezoelectric sensor placed over the
skin on the volar aspect of the wrist, connected to a data-capture control box, was
used to collect venous waveforms in 96 patients during RHC. PCWP was collected at
end-expiration by an experienced cardiologist. The venous waveform signal was transformed
to the frequency domain (Fourier transform), where a ratiometric algorithm of the
frequencies of the pulse rate and its harmonics was used to derive a NIVA value. NIVA
values were successfully captured in 83 of 96 enrolled patients. PCWP ranged from
4–40 mmHg with a median of 13 mmHg. NIVA values demonstrated a linear correlation
with PCWP (r = 0.69, P < 0.05).
Conclusions
This observational proof-of-concept study using a prototype NIVA device demonstrates
a moderate correlation between NIVA value and PCWP in patients undergoing RHC. NIVA,
thus, represents a promising developing technology for noninvasive assessment of congestion
in spontaneously breathing patients.
Key Words
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Article info
Publication history
Published online: September 28, 2019
Accepted:
September 19,
2019
Received in revised form:
September 6,
2019
Received:
April 1,
2019
Footnotes
Work Performed: Vanderbilt University Medical Center.
Statement for Reprints: none ordered.
Identification
Copyright
Published by Elsevier Inc.
