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Sheridan WS, Wetterling F, Testani JM, Borlaug BA, Fudim M, Damman K, Gray A, Gaines P, Poloczek M, Madden S, Tucker J, Buxo T, Gaul R, Corcoran L, Sweeney F, Burkhoff D. Safety and performance of a novel implantable sensor in the inferior vena cava under acute and chronic intravascular volume modulation. Eur J Heart Fail 2023; 25:754-763. [PMID: 36891760 DOI: 10.1002/ejhf.2822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
AIMS The management of congestion is one of the key treatment targets in heart failure. Assessing congestion is, however, difficult. The purpose of this study was to investigate the safety and dynamic response of a novel, passive, inferior vena cava (IVC) sensor in a chronic ovine model. METHODS AND RESULTS A total of 20 sheep divided into three groups were studied in acute and chronic in vivo settings. Group I and Group II included 14 sheep in total with 12 sheep receiving the sensor and two sheep receiving a control device (IVC filter). Group III included an additional six animals for studying responses to volume challenges via infusion of blood and saline solutions. Deployment was 100% successful with all devices implanted; performing as expected with no device-related complications and signals were received at all observations. At similar volume states no significant differences in IVC area normalized to absolute area range were measured (55 ± 17% on day 0 and 62 ± 12% on day 120, p = 0.51). Chronically, the sensors were completely integrated with a thin, reendothelialized neointima with no loss of sensitivity to infused volume. Normalized IVC area changed significantly from 25 ± 17% to 43 ± 11% (p = 0.007) with 300 ml infused. In contrast, right atrial pressure required 1200 ml of infused volume prior to a statistically significant change from 3.1 ± 2.6 mmHg to 7.5 ± 2.0 mmHg (p = 0.02). CONCLUSION In conclusion, IVC area can be measured remotely in real-time using a safe, accurate, wireless, and chronic implantable sensor promising to detect congestion with higher sensitivity than filling pressures.
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Affiliation(s)
| | | | - Jeffrey Moore Testani
- Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, NC, USA
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Alastair Gray
- Department of Cardiology, Craigavon Area Hospital, Craigavon, UK
| | | | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James Tucker
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
| | - Teresa Buxo
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
| | - Robert Gaul
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
| | - Louise Corcoran
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
| | - Fiachra Sweeney
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
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Cogliati C, Ceriani E, Gambassi G, De Matteis G, Perlini S, Perrone T, Muiesan ML, Salvetti M, Leidi F, Ferrara F, Sabbà C, Suppressa P, Fracanzani A, Montano N, Fiorelli E, Tripepi G, Gori M, Pitino A, Pietrangelo A. Phenotyping congestion in patients with acutely decompensated heart failure with preserved and reduced ejection fraction: The Decongestion duRing therapY for acute decOmpensated heart failure in HFpEF vs HFrEF- DRY-OFF study. Eur J Intern Med 2022; 97:69-77. [PMID: 34844795 DOI: 10.1016/j.ejim.2021.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/20/2022]
Abstract
AIMS To evaluate pulmonary and intravascular congestion at admission and repeatedly during hospitalization for acute decompensated heart failure (ADHF) in HFrEF and HFpEF patients using lung (LUS) and inferior vena cava (IVC) ultrasound. METHODS AND RESULTS Three-hundred-fourteen patients (82±9 years; HFpEF =172; HFrEF=142) admitted to Internal Medicine wards for ADHF were enrolled in a multi-center prospective study. At admission HFrEF presented higher indexes of pulmonary and intravascular congestion (LUS-score: 0.9 ± 0.4 vs 0.7 ± 0.4; p<0.01; IVC end-expiratory diameter: 21.6 ± 5.1 mm vs 20±5.5 mm, p<0.01; IVC collapsibility index 24.4 ± 17.4% vs 30.9 ± 21.1% p<0.01) and higher Nt-proBNP values (8010 vs 3900 ng/l; p<0.001). At discharge, HFrEF still presented higher B-scores (0.4 ± 4 vs 0.3 ± 0.4; p = 0.023), while intravascular congestion improved to a greater extent, thus IVC measurements were similar in the two groups. No differences in diuretic doses, urine output, hemoconcentration, worsening renal function were found. At 90-days follow up HF readmission/death did not differ in HFpEF and HFrEF (28% vs 31%, p = 0,48). Residual congestion was associated with HF readmission/death considering the whole population; while intravascular congestion predicted readmission/death in the HFrEF, no association between sonographic indexes and the outcome was found in HFpEF. CONCLUSIONS Serial assessment of pulmonary and intravascular congestion revealed a higher burden of fluid overload in HFrEF and, conversely, a greater reduction in intravascular venous congestion with diuretic treatment. Although other factors beyond EF could play a role in congestion/decongestion patterns, our data may be relevant for further phenotyping HF patients, considering the importance of decongestion optimization in the clinical approach.
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Affiliation(s)
- C Cogliati
- Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli- Sacco, Italy
| | - E Ceriani
- Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli- Sacco, Italy.
| | - G Gambassi
- Department of Medicine and Traslational Surgery, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Perlini
- Emergency Department, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - T Perrone
- Internal Medicine 1, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - M L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia-ASST Spedali Civili Brescia, Brescia, Italy
| | - M Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia-ASST Spedali Civili Brescia, Brescia, Italy
| | - F Leidi
- Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli- Sacco, Italy
| | - F Ferrara
- Department of Internal and Emergency Medicine, University Hospital of Modena, Italy
| | - C Sabbà
- Division of Internal Medicine and Geriatrics, DIM Department, University of Bari, Italy
| | - P Suppressa
- Division of Internal Medicine and Geriatrics, DIM Department, University of Bari, Italy
| | - A Fracanzani
- Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
| | - N Montano
- Department of Clinical Sciences and Health Community, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
| | - E Fiorelli
- Department of Clinical Sciences and Health Community, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
| | - G Tripepi
- Institute of Clinical Physiology (IFC-CNR), Section of Reggio Calabria, Italy
| | - M Gori
- Institute of Clinical Physiology (IFC-CNR), Section of Rome, Italy
| | - A Pitino
- Institute of Clinical Physiology (IFC-CNR), Section of Rome, Italy
| | - A Pietrangelo
- Department of Internal and Emergency Medicine, University Hospital of Modena, Italy
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