New non-invasive test to assess the blood volume in health and disease

New Non-invasive Test to Assess the Blood 
Volume in Health and Disease 
 Dr. Thach Nguyen, Bui Mai Thuy Tien 
•Syncope: diagnosed by history 
• Heart failure (HF) : non-specific physical findings 
 non-pathognomonic 
•Clinical confounders: COPD, hepatic cirrhosis , dehydration, 
chronic kidney disease (CKD). 
 Need specific test to: 
 Diagnosing HF/cardiovascular dysfunction 
 Guiding management of HF 
Why should we need new method? 
• History: syncope, orthostatic hypotension or HF on top of 
COPD, chronic kidney disease (CKD). 
•Control group: standard testing and treatment for HF. 
•Study group: measuring femoral vein’s size at baseline during 
cough. 
Which patients can be enrolled? 
The first principle: Blood volume of femoral artery and 
common femoral vein: same . 
Normal condition, size of the femoral artery and the 
femoral vein: same. 
If venous return is lower =>edema in lower leg. 
SEFV TEST’S PRINCIPLES 
SEFV test: the Size and Expansion of the Femoral Vein test 
The second principle: 
•In veins: containing most circulating blood . 
•In arteries: 
 Blood volume :small 
 Size: not change much due to vascular tone. 
 =>Increasing cardiac output, increasing 
heart rate. 
 Changing size of femoral vein depends on blood 
volume in intravascular compartment 
SEFV TEST’S PRINCIPLES 
SEFV test is 
• The ultrasound study examining size and expansion 
of common femoral vein during cough. 
•A fairly accurate method to assess the arterial and 
venous volume could be achieved. 
The ultrasound plane: coronal plane immediately 
proximal to bifurcation of superficial- deep femoral 
artery. 
WHAT IS SEFV TEST? 
Bifurcation as the femoral artery divides into the superficial and deep 
femoral arteries. 
New Non-Invasive SEFV Test 
In normal fluid status, the size of the femoral vein > the size of the 
common femoral artery. 
New Non-Invasive SEFV Test 
The coronal plane of the artery: a single round structure. 
Normal expansion of the femoral vein to less than 2 times larger than the baseline 
 (Without fluid overload or dehydration) 
New Non-Invasive SEFV Test 
•Fluid overload 
•Excessive venous pooling causing syncope 
•Venous compartment contraction due to Blood Loss, 
Dehydration or Pulmonary Hypertension. 
SEFV in DISEASE 
The size of the vein is more than 3 times larger than the size of the 
femoral artery. 
The vein is expanded maximally => cannot expand further with cough. 
Fluid Overload 
A patient with heart failure 
a 
Femoral vein is >3 times larger than its baseline => abnormal 
suggesting excessive venous pooling causing orthostatic 
hypotension . 
Excessive Venous Pooling Causing Syncope 
Panel A Panel B 
Panel A. The femoral vein at its baseline. Panel B. The femoral vein expanded 
to a huge volume upon cough. 
•Femoral vein not expand (barely filled with blood and no 
extra volume even with higher pressure from the lungs) with 
cough, patient has suboptimal venous capacity (e.g. 
secondary to dehydration or bleeding). 
•In pulmonary hypertension, femoral vein not expand with 
cough. 
Venous Compartment Contraction due to 
Blood Loss, Dehydration or Pulmonary 
Hypertension 
Abnormal expansion of the femoral vein 
December 2015 -> May 2016 : 25 patients having clinical diagnosis 
syncope, persistent orthostatic hypotension, HF on top of hepatic 
cirrhosis or COPD or CKD. 
 With SEFV test, confirming the diagnosis of fluid overload in patients 
with severe non cardiac disease. 
What did we find? 
EFV Test (+) % EFV Test (-) % P value 
Syncope 35 65 
Orthostatic Hypotension 80 20 <0.05 
Vasovagal syncope 80 20 <0.05 
Near syncope 20 80 <0.05 
HF on top of Cirrhosis 75 25 <0.05 
HF on top of COPD 45 55 >0.05 
HF on top of CKD With HD 65 35 <0.05 
HF on top of CKD without HD 70 30 <0.05 
•Patients with complex disease, the EFV could confirm early the 
presence of HF and guide its treatment amid of multiple complex 
confounders. Larger scale of clinical trial or registries of this new 
technique are needed. 
•Larger scale of clinical trial or registries of this new technique are 
needed. 
WHAT DID WE FIND? 
Thanks for your listening!