New definition and best assessment of heart failure: A first-in-man application of a new technique

New Definition and Best 
Assessment of Heart Failure: 
 A First-in-Man Application of 
a New Technique 
Thach Nguyen MD FACC FSCAI 
Methodist Hospital, Merrillville IN 
At the Vietnam Heart Association Meeting 
October 10th 2016 
 Symptoms and Signs of Heart Failure Are 
Non Specific 
 The same symptoms and signs can be 
found in Heart failure, 
 COPD, 
 Chronic kidney failure 
 Cirrhosis of the liver 
 Pulmonary hypertension 
 Pericarditis 
1. When I am consulted to see a patient 
with possible heart failure, after I examine 
the patient, what is my answer? 
I don’t know whether the patient has HF 
however what I am sure is whether the 
patient has fluid overload 
2. Does the patient have extravascular fluid 
overload? Does the patient have 
intravascular fluid overload? 
Extravascular Fluid Overload 
Intravascular Fluid Overload 
The new classification: 
The Vietnam Classification of Heart Failure 
IntraV ExtraV E F Patient Profile 
 - - High A. Normal heart, no fluid overload 
 - + High B. Normal heart with fluid overload (Healthy sick) 
 + - High C. Compromised LV function (e.g. stiff LV due to age) (easy 
to get sick) 
(Vulnerable, mildly sick person) 
 + + High D. Symptomatic compromised LV diastolic function (stiff LV 
due to age) 
(Really sick, Recover fast and stay healthy for long time) 
Profile A: No Extravascular No 
Intravascular Fluid Overload. normal 
heart (Not Sick) 
Profile B: Extravasc (+) Intravasc (-) 
Fluid Overload, normal EF (Healthy Sick) 
Profile C: Extravasc (-) Intravasc (+) Fluid 
Overload, Norm EF. Not sick now, easy to 
become sick (vulnerable person) 
Profile D: Intravasc (+) Extravac (+) 
Fluid Overload, Normal EF: Sick Patient 
(however patient will recover and stay 
healthy if treated well) 
Profile A1: I (-) E (-) Low EF 
Well Compensated Patient with LVAD 
Profile B1: I (-) E (+) Low EF 
Mildly symptomatic, Improved with 
treatment and prevention 
Profile C1: I (+) E (-) Low EF 
Very Vulnerable: Pseudo-stable 
Profile D1: I (+) E (+) Low EF 
Really Sick 
Intr
aV 
Extra
V 
E F Patient Profile 
 - - High A. Normal heart, no fluid overload 
 - + High B. Normal heart with fluid overload 
(Healthy sick) 
 + - High C. Compromised LV function (e.g. 
stiff LV due to age) (easy to get sick) 
(Vulnerable, mildly sick person) 
 + + High D. Symptomatic compromised LV 
diastolic function (stiff LV due to age) 
(Really sick, Recover fast and stay 
healthy for long time) 
This classification is better than the 
ACC/AHA, NYHA classification 
Why is this classification relevant? 
1. Because it can give an exact assessment 
of the present condition 
 A. Intravascular fluid 
 B. Extravascular fluid 
 C. Ejection fraction 
2. Because it can show where to remove the 
fluid 
 A. Intravascular fluid 
 B. Extravascular fluid 
3. Because it can predict short term and 
long term future 
 Extra> Intra > low EF 
ROAD MAP 
Toward recovery 
Disease Progress 
ROAD MAP 1 
Toward recovery 
Disease Progress 
Problems in Premature Discharge 
and Early Readmissions 
B1 (I- E+) C1 (I+ E-) D1 (I+E+ 
CLINICAL PEARL 
Which patient with HF will develop high 
BUN and creatinine with just one dose of 
20mg IV furosemide? 
Patient with intravascular 
contraction and extravascular fluid 
overload 
B1 (I- E+) 
Can Physical Examination detect 
accurately intervascular fluid overload? 
Vascular Probe with Regular Echo 
Equipment 
Location to measure the size of the 
femoral artery and vein 
Femoral Vein 
Femoral Artery 
Patient with Fluid overload 
Much larger femoral vein 
Femoral Artery 
Patient with Bleeding 
Smaller Femoral Vein 
Femoral Artery 
Patient with syncope due to orthostatic 
hypotension (excessive venous dilation) 
Huge Femoral Vein with cough 
Femoral Vein 
at baseline 
Patient with Enlarged Femoral Vein and 
Normal EF= Diastolic HF. The heart is not 
sick. The capacitance of the venous system is 
overwhelmed 
This new technique is useful in 
1. Diagnosis of heart failure, 
2. Extent of internal acute blood loss, 
3. Diagnosis of syncope 
4. Diagnosis of orthostatic hypotension, 
5. Confirm HF in patient with COPD, 
6. Confirm HF with chronic kidney dis. 
7. Confirm HF in patient with cirrhosis 
8. Confimr fluid overload in patient with 
normal EF (misnomer diastolic HF) 
Extravascular Fluid Overload 
Intravascular Fluid Overload 
Intr
aV 
Extra
V 
E F Patient Profile 
 - - High A. Normal heart, no fluid overload 
 - + High B. Normal heart with fluid overload 
(Healthy sick) 
 + - High C. Compromised LV function (e.g. 
stiff LV due to age) (easy to get sick) 
(Vulnerable, mildly sick person) 
 + + High D. Symptomatic compromised LV 
diastolic function (stiff LV due to age) 
(Really sick, Recover fast and stay 
healthy for long time) 
This classification is better than the 
ACC/AHA, NYHA classification 
Patient with Fluid overload 
Much larger femoral vein 
Femoral Artery 
ROAD MAP 
Toward recovery 
Disease Progress 
ROAD MAP 1 
Toward recovery 
Disease Progress 
Problems in Premature Discharges 
and Early Readmissions 
B1 (I- E+) C1 (I+ E-) D1 (I+E+ 
1. Diagnosis of heart failure, 
2. Extent of internal acute blood loss, 
3. Diagnosis of syncope 
4. Diagnosis of orthostatic hypotension, 
5. Confirm HF in patient with COPD, 
6. Confirm HF with chronic kidney dis. 
7. Confirm HF in patient with cirrhosis 
8. Confimr fluid overload in patient with 
normal EF (misnomer diastolic HF) 
Intr
aV 
Extra
V 
E F Patient Profile 
 - - High A. Normal heart, no fluid overload 
 - + High B. Normal heart with fluid overload 
(Healthy sick) 
 + - High C. Compromised LV function (e.g. 
stiff LV due to age) (easy to get sick) 
(Vulnerable, mildly sick person) 
 + + High D. Symptomatic compromised LV 
diastolic function (stiff LV due to age) 
(Really sick, Recover fast and stay 
healthy for long time) 
This classification is better than the 
ACC/AHA, NYHA classification 
Patient with Fluid overload 
Much larger femoral vein 
Femoral Artery 
Thank You 
Contact for new clinical trial: 
thachnguyen 2000@yahoo.com