Peripheral Venous Pressure Research Articles

Clinical characteristics of hemodynamics and laboratory parameters of recipients during orthotopic heart transplantation

Objective. To study the clinical and laboratory characteristics of recipients during orthotopic heart transplantation according to intraoperative monitoring. Materials and methods. The clinical and laboratory data of 38 patients who underwent orthotopic heart transplantation for vital indications in the period from 2022 to 2024 were studied. The average age of patients was (38.5 ± 13.5) years. There were 35 men (92.1%) and 3 women (7.9%). Peripheral oxygen saturation, arterial and central venous pressure were measured in each recipient delivered to the operating room at 5 stages of the operation during orthotopic heart transplantation. Results. The main cause of chronic heart failure with subsequent heart transplantation in all 38 (100%) patients was dilated cardiomyopathy. Statistically significant (p < 0.05) acidosis and hypercapnia in recipients during heart transplantation were most pronounced at the first stage of surgery, before the connection of a heart–lung machine. Acidosis during heart transplantation had a mixed metabolic and respiratory genesis with hypercapnia and lactatacidosis. A statistically significant (p < 0.05) increased lactate content at the first and second stages and statistically significant (p < 0.05) hyperglycemia at all stages of surgery were found. Central venous pressure was statistically significantly (p<0.05) higher than the reference values at the stages of sternum cutting and before the connection of the heart–lung machine. A direct statistically significant (p<0.05) correlation between the level of arterial blood pH and the level of central venous pressure (r=0.334) was established, with the corresponding linear regression equation: pH=4.7043+central venous pressure × 0.02391. Conclusions. Clinical and laboratory characteristics of recipients undergoing orthotopic heart transplantation demonstrated a direct correlation between mixed metabolic and respiratory acidosis and central venous pressure. Peripheral hemodynamic parameters in orthotopic heart transplantation were characterized by instability at the stage of heart–lung machine disconnection.

Prospective randomized evaluation of transcutaneous carbon dioxide monitoring during complex electrophysiological procedures under deep sedation: the TRACES trial.

The field of interventional electrophysiology is rapidly growing. For safe and efficient procedures sedation is needed for patient comfort and immobility. However, sedative and analgesic agents can induce respiratory depression, risking hypercapnia, hypoxia, and hypotension. This study evaluates the impact of adding transcutaneous carbon-dioxide (CO2) monitoring to standard monitoring practices in electrophysiological procedures under deep sedation. This prospective, randomized study at Ulm University Heart Center included 726 patients undergoing treatment under deep sedation between August 2019 and October 2023. Patients were randomly assigned to standard monitoring or standard monitoring with continuous transcutaneous CO2 monitoring (TCM-group). Standard monitoring involved non-invasive blood pressure, oxygen saturation (SpO2), and frequent peripheral venous blood gas analysis. The primary composite endpoint was SpO2 dips below 90% and pathological changes in venous blood gas analysis. The TCM-group included 357 patients, and the standard group had 348. The primary composite endpoint was reached by 195 patients (54.8%) in the TCM-group and 195 patients (56.5%) in the standard group (p = 0.642). However, peripheral venous CO2 partial pressure increased by more than 30% from baseline more often in the standard group than in the TCM-group (p = 0.005). Additionally, a venous pH below 7.25 was more common in the standard group (p = 0.047). While transcutaneous CO2 monitoring offers no significant benefit for the primary combined endpoint over standard monitoring during electrophysiological procedures, it helps mitigate significant CO2 elevations and respiratory acidosis. ClinicalTrials.gov, NCT04038476, 29 July 2019.

Impact of the Valsalva manoeuvre on the choroid: A systematic review with meta-analyses.

A variety of daily activities can intentionally or unintentionally cause the Valsalva manoeuvre, which induces a physiological response of elevated peripheral venous pressure. Studies have speculated that it may ultimately affect the choroidal anatomy. This is particularly important from a clinical point-of-view since patients occasionally hold their breath while undergoing macular optical coherence tomography (OCT). In this study, we systematically reviewed the literature to understand the impact of the Valsalva manoeuvre on the choroid and conducted meta-analyses on the changes induced in the subfoveal choroidal thickness (SFCT) and the choroidal vascularity index (CVI). We searched 12 literature databases for studies in healthy participants undergoing Valsalva manoeuvre with choroidal OCT scans before and during the manoeuvre. Seven studies with a total of 444 eyes of 279 individuals were eligible for the review. The Valsalva manoeuvre led to a statistically significant but numerically small increase in the SFCT of 6.5 μm (95% CI: 1.6-11.4 μm; p = 0.01) and a statistically significant increase in the CVI of 1.48 (95% CI: 1.23-1.73; p = 0.0002). Thus, the Valsalva manoeuvre has a measurable impact on the choroid, and we recommend careful observation of how the patient sits and behaves behind the OCT scanner while scanning in order to allow accurate measurements of the choroid for diagnosis and monitoring.

Peripheral Venous Pressure And NT-proBNP Phenotypes as Surrogates for Invasive Fontan Haemodynamics in Adults

We hypothesized that phenotyping patients using a combination of resting peripheral venous pressure (PVP) and N-terminal pro–brain natriuretic peptide (NT-proBNP) would predict invasive Fontan haemodynamics. Accordingly, 35 adults with a history of Fontan palliation were categorized into 3 groups according to PVP and NT-proBNP values: normal, ↑NT-proBNP (≥300 pg/dL) or ↑PVP (≥15 mm Hg), and ↑PVP+↑NT-proBNP. Those in the normal values group universally had normal resting pulmonary artery wedge and Fontan pressures, with a single patient having abnormal exercise values; conversely, all patients in the ↑PVP+↑NT-proBNP group had increased resting Fontan or pulmonary artery wedge pressures, with those in the ↑NT-proBNP or ↑PVP group constituting an intermediate group.

Sympathoinhibition during cardiopulmonary baroreceptor loading is attenuated in older females.

The purpose of the present study was to clarify the impact of age on the sympathoinhibitory response to cardiopulmonary baroreceptor loading in females. Nine older females (mean±SD, 70±6 years) and eleven younger females (20±1 years) completed the study. A passive leg raising (PLR) test was performed wherein the participants were positioned supine (baseline, 0º), and their lower limbs were passively lifted at 10º, 20º, 30º, and 40º (3 min at each angle). Muscle sympathetic nerve activity (MSNA) was recorded via microneurography of the left radial nerve. The central venous pressure was estimated based on peripheral venous pressure (eCVP), which was monitored using a cannula in the right large antecubital vein. Baseline MSNA was higher in older females compared to younger females. MSNA burst frequency (BF) decreased during the PLR test in both older and younger females, but the magnitude of the decrease in MSNA BF was smaller in older females than in younger females (older, -3.5±1.5 vs. younger, -6.3±1.5 bursts/min at 40º from baseline, P=0.014). The eCVP increased during the PLR in both groups, and there was no difference in the changes in eCVP between the two groups (older, +1.07±0.37 vs. younger, +1.12±0.33 mmHg at 40º from baseline, P=0.941). These results suggest that inhibition of sympathetic vasomotor outflow during cardiopulmonary baroreceptor loading could be blunted with advancing age in females.

Peripheral Venous Pressure+Fenestration Doppler=Noninvasive Cardiac Catheterization Post-Fontan.

Peripheral Venous Pressure+Fenestration Doppler=Noninvasive Cardiac Catheterization Post-Fontan.

Noninvasive measurement of ambulatory venous pressure via column interruption duration in chronic venous disease

BackgroundColumn interruption duration (CID) is a noninvasive surrogate for venous refill time (VFT), a parameter used in ambulatory venous pressure measurement. CID is more accurate than invasive VFT measurement because it avoids errors involved with indirect access of the deep system through the dorsal foot vein. The aim of this retrospective single center study is to analyze the clinical usefulness of CID in assessment of chronic venous disease (CVD). MethodsA total of 1551 limbs (777 patients) were referred with CVD symptoms over a 5-year period (2018-2023); CID, air plethysmography, and duplex reflux data were analyzed. Of these limbs, 679 had supine venous pressure data as well. The pathology was categorized as obstruction if supine peripheral venous pressure was >11 mm Hg and as reflux if duplex reflux time in superficial or deep veins was >1 second. CID was measured via Doppler monitoring of flow in the great saphenous vein (GSV) and one of the paired posterior tibial (PT) veins near the ankle in the erect posture. The calf is emptied by rapid inflation cuff. CID is the time interval in seconds when cephalad venous flow in great saphenous vein and posterior tibial veins reappear after calf ejection. A CID <20 seconds in either vein is abnormal similar to the threshold used in VFT measurement. ResultsThirty-two percent of the limbs had obstruction, 17% had reflux, and 37% had a combination; 14% had neither. Higher clinical-etiology-anatomy-pathophysiology (CEAP) clinical classes (C4-6) were prevalent in 44% of pure reflux, significantly less (P < .0001) than in pure obstruction (73%) or obstruction plus reflux subsets (72%), partly reflecting distribution of pathology. There is a progressive increase in supine venous pressure and abnormal CID (P < .0001 and P < .0001, respectively) in successive CEAP clinical class. No such correlation between CEAP and any of the reflux severity grading methods (reflux segment score, Venous Filling Index, and Kistner axial grading) was observed. Abnormal CID (55%) was more prevalent in higher CEAP classes (>4) (P < .0001) than in lesser clinical classes (0-2) or limbs with neither obstruction nor reflux (P < .01). ConclusionsObstruction seems to be a more dominant pathology in clinical progression among CEAP clinical classes than reflux. CID is abnormal in both obstructive and refluxive pathologies and may represent a common end pathway for similar clinical manifestations (eg, ulcer). These data suggest a useful role for CID measurement in clinical assessment of limbs with CVD.

Peripheral Venous Pressure Accurately Reflects Invasively Measured Resting and Exercise Fontan Pressures

Peripheral Venous Pressure Accurately Reflects Invasively Measured Resting and Exercise Fontan Pressures

Total pulmonary resistance as assessed by non-invasive pressure-flow plots is related to exercise capacity in Fontan patients

Abstract Background In Fontan patients, the slope of invasively measured pulmonary artery pressures plotted against cardiac output (CO) during exercise has prognostic significance. We propose a methodology using exercise echocardiography combined with cardiopulmonary exercise testing and simultaneous peripheral venous pressure measurements (CPET-echo-PVP) to calculate PVP/CO slopes as a non-invasive alternative. Purposes This study aimed at assessing (1) PVP/CO slopes and (2) their relationship with peak oxygen consumption in Fontan patients. Material and Methods Consecutive adult Fontan patients seen in the outpatient clinic at UZ Leuven, Belgium were included in the study. All patients underwent CPET-echo-PVP (peripheral intravenous line connected to the pressure transducer zeroed at the mid-axillary level). Bloodwork was performed, including N-terminal prohormone of brain natriuretic peptide (NTproBNP). The PVP/CO slope was calculated as a linear approximation using linear regression analysis from pressure-flow plots for each patient. Univariable regression analysis was performed to identify potential determinants of PVP/CO slope. Results In total 20 patients (mean age 30.5±10.4 (range 20-60), 11[55%] females, dominant left ventricle in 15 [75%]) were included. NT-proBNP was 297±235 pg/mL. Patients performed staged exercise test achieving workload of 102±30 Watts with a peak oxygen consumption (peakVO2) of 19.2±3.8 mL/kg/min. During exercise cardiac output (CO), heart rate (HR) and PVP all increased (mean difference: 4.1±2.2L/min, 57±26bpm, 10.4±5.9mmHg, respectively). Stroke volume index (SVind) increased from baseline to peak exercise in 9 (45%) (mean difference -2.6±12.0mL/m2). The average PVP/CO slope was 2.21±1.53mmHg/L*min, with the value exceeding 3mmHg/L*min in 5 (25%) patients. PeakVO2, peak Workload during exercise, NTproBNP, New York Heart Association (NYHA) class, and rest-to-peak change in tissue-Doppler e’ (delta e’) of the lateral wall of dominant ventricle were significantly related to the PVP/CO slope (all p&amp;lt;0.05). Conclusions CPET-echo with PVP is a reliable method to identify determinants of exercise limitation in Fontan patients. The PVP/CO slope, which reflects total pulmonary resistance, is indeed related to peak oxygen consumption, heart rate reserve and diastolic function. Since it reflects hydraulic load to the systemic venous system it may be an important target in Fontan patients.

Abstract 14769: Peripheral Venous Pressure Measured With a Novel Miniature Pressure Transducer Correlates With Central Venous Pressure in Heart Failure, Heart Transplant, and Left Ventricular Assist Device Patients

Introduction: Peripheral venous pressure (PVP) has been shown to accurately correlate with central venous pressure (CVP) when measured using a conventional manometer and pressure tubing. We investigated the correlation between PVP as measured by a novel pressure transducer and CVP in heart failure (HF), heart transplant (HTx), and left ventricular assist device (LVAD) patients. Methods: A prospective, cross-sectional study examining PVP from February 2022 to May 2023 was conducted. The analysis was limited to patients undergoing right heart catheterization (RHC) admitted for HF, post-HTx monitoring, or LVAD hemodynamic testing. PVP was transduced from an antecubital or more distal peripheral intravenous (IV) catheter site using a miniature digital, disposable pressure transducer (Centurion Compass Universal HG, Medline). Pressures were compared using Pearson’s correlation coefficient. Results: 99 patients were enrolled with a mean age of 62 ± 12 years and a mean ejection fraction (EF) of 41 ± 21%. 74% of the patients had heart failure, 17% were HTx patients, and 9% were LVAD patients. The PVP measured with the novel pressure transducer was found to be highly correlated to CVP measured by RHC (r=0.80, p &lt; 0.0001) (Figure). High correlation was also noted when broken down by HF (r=0.77, p &lt; 0.0001), HTx (r=0.95, p &lt; 0.0001), and LVAD groups (r=0.90, p &lt; 0.0003). There was a high degree of correlation for HF patients with EF &lt; 50% (r=0.74, p &lt; 0.0001) and EF &gt; 50% (r=0.90, p &lt; 0.0001). A high degree of correlation was found for all peripheral IV insertion sites: antecubital (r=0.86, p=0.000071), forearm (r=0.76, p&lt;0.00001), and hand (r=0.84, p&lt;0.00001). Conclusions: There is a high degree of correlation between PVP measured by a novel pressure transducer and CVP in HF, HTx, and LVAD patients. PVP measurements using this transducer are a reliable estimate of volume status in these patient populations.

Association Between the Liver Fibrosis Markers and Scores, and Hemodynamic Congestion Assessed by Peripheral Venous Pressure in Patients With Acute Heart Failure.

Background Peripheral venous pressure (PVP) has been shown to be a reliable surrogate for right atrial pressure in assessing congestion in patients with heart failure (HF). Liver fibrosis markers and scores can be useful in assessing organ injury in patients with acute HF. This study aimed to investigate the association of liver fibrosis markers and scores with PVP in patients with acute HF. Methods and Results The 7S domain of the collagen type IV N-terminal propeptide (P4NP 7S), aspartate aminotransferase-to-platelet ratio index, fibrosis-4, and nonalcoholic fatty liver disease fibrosis score were determined along with PVP measurements before discharge in 229 patients with acute HF. The strongest correlation with PVP was found for P4NP 7S (Pearson r=0.40). Patients with high P4NP 7S levels (≥median [6.2 ng/mL]) had an increased risk of cardiovascular death or HF hospitalization (adjusted hazard ratio [HR], 1.80 [95% CI, 1.09-3.04], P=0.02). The concomitant high PVP (≥mean [8 mm Hg])/high P4NP 7S group, in contrast to the high PVP/low P4NP 7S or low PVP/high P4NP 7S group, had a significant risk relative to the low PVP/low P4NP 7S group for cardiovascular death or HF hospitalization (adjusted HR, 2.63 [95% CI, 1.43-5.05], P=0.002). A sustained elevation in PVP for 1 month postdischarge was associated with a persistent increase in P4NP 7S. Conclusions The study demonstrated the relationship between the liver fibrosis marker P4NP 7S and congestion. PVP and P4NP 7S could be useful for assessing congestion-related organ injury and predicting prognosis in patients with acute HF.

Signal quality assessment of peripheral venous pressure.

Develop a signal quality index (SQI) for the widely available peripheral venous pressure waveform (PVP). We focus on the quality of the cardiac component in PVP. We model PVP by the adaptive non-harmonic model. When the cardiac component in PVP is stronger, the PVP is defined to have a higher quality. This signal quality is quantified by applying the synchrosqueezing transform to decompose the cardiac component out of PVP, and the SQI is defined as a value between 0 and 1. A database collected during the lower body negative pressure experiment is utilized to validate the developed SQI. All signals are labeled into categories of low and high qualities by experts. A support vector machine (SVM) learning model is trained for practical purpose. The developed signal quality index coincide with human experts' labels with the area under the curve 0.95. In a leave-one-subject-out cross validation (LOSOCV), the SQI achieves accuracy 0.89 and F1 0.88, which is consistently higher than other commonly used signal qualities, including entropy, power and mean venous pressure. The trained SVM model trained with SQI, entropy, power and mean venous pressure could achieve an accuracy 0.92 and F1 0.91 under LOSOCV. An exterior validation of SQI achieves accuracy 0.87 and F1 0.92; an exterior validation of the SVM model achieves accuracy 0.95 and F1 0.96. The developed SQI has a convincing potential to help identify high quality PVP segments for further hemodynamic study. This is the first work aiming to quantify the signal quality of the widely applied PVP waveform.

Diagnostic accuracy of the peripheral venous pressure variation induced by an alveolar recruitment maneuver to predict fluid responsiveness during high-risk abdominal surgery

BackgroundIn patients undergoing high-risk surgery, it is recommended to titrate fluid administration using stroke volume or a dynamic variable of fluid responsiveness (FR). However, this strategy usually requires the use of a hemodynamic monitor and/or an arterial catheter. Recently, it has been shown that variations of central venous pressure (ΔCVP) during an alveolar recruitment maneuver (ARM) can predict FR and that there is a correlation between CVP and peripheral venous pressure (PVP). This prospective study tested the hypothesis that variations of PVP (ΔPVP) induced by an ARM could predict FR.MethodsWe studied 60 consecutive patients scheduled for high-risk abdominal surgery, excluding those with preoperative cardiac arrhythmias or right ventricular dysfunction. All patients had a peripheral venous catheter, a central venous catheter and a radial arterial catheter linked to a pulse contour monitoring device. PVP was always measured via an 18-gauge catheter inserted at the antecubital fossa. Then an ARM consisting of a standardized gas insufflation to reach a plateau of 30 cmH2O for 30 s was performed before skin incision. Invasive mean arterial pressure (MAP), pulse pressure, heart rate, CVP, PVP, pulse pressure variation (PPV), and stroke volume index (SVI) were recorded before ARM (T1), at the end of ARM (T2), before volume expansion (T3), and one minute after volume expansion (T4). Receiver-operating curves (ROC) analysis with the corresponding grey zone approach were performed to assess the ability of ∆PVP (index test) to predict FR, defined as an ≥ 10% increase in SVI following the administration of a 4 ml/kg balanced crystalloid solution over 5 min.Results∆PVP during ARM predicted FR with an area under the ROC curve of 0.76 (95%CI, 0.63 to 0.86). The optimal threshold determined by the Youden Index was a ∆PVP value of 5 mmHg (95%CI, 4 to 6) with a sensitivity of 66% (95%CI, 47 to 81) and a specificity of 82% (95%CI, 63 to 94). The AUC’s for predicting FR were not different between ΔPVP, ΔCVP, and PPV.ConclusionDuring high-risk abdominal surgery, ∆PVP induced by an ARM can moderately predict FR. Nevertheless, other hemodynamic variables did not perform better.

Modeling peripheral arterial and venous pressure signals with integral pulse frequency modulation

This paper proposes a novel mathematical modeling framework for peripheral arterial and peripheral venous blood pressure signals from porcine experiments. Peripheral blood pressure signals can be acquired using regular catheters during standard patient treatment. The minimally invasive nature and ubiquitous availability of catheters render it an ideal candidate for various applications. However, there is no analytical model for peripheral blood pressure signals in the literature. We address this issue by proposing a model for these signals under the integral pulse frequency modulation (IPFM) framework. The model incorporates the impacts of physiological phenomena, such as the heartbeat pulse shape variation, heart rate variability, respiratory rate, etc. The model parameters are obtained by applying the IPFM model to experimental data collected from four pigs under different anesthetic dosages. The proposed model can fit the experimental data with Pearson correlation coefficients greater than 0.99 and 0.90 for arterial and venous blood pressure signals, respectively. The performance of model-synthesized data on the classification of two different anesthesia is comparable with experimental data. Parameters like pulse shape and duration can also work as distinguishable features under different anesthesia. We also proposed a way to distinguish respiratory-induced heart rate variability from other causes. Increasing doses of vasodilating anesthesia is similar to going from dehydration to hydration. Thus the results obtained in this study can be extended in distinguishing hydrated and dehydrated subjects. This model can be extended to similar biomedical signals like photoplethysmography, cerebral blood flow velocity, and Doppler waveforms.

Exercise Pathophysiology and Testing in Individuals With a Fontan Circulation.

The Fontan circulation, a surgical palliation for single-ventricle congenital heart disease, profoundly impacts the cardiopulmonary response to exercise. Reliant on passive pulmonary blood flow, the Fontan circulation has limited capacity to augment cardiac output as necessary to supply working muscles during exercise. Cardiopulmonary exercise testing (CPET) objectively assesses cardiorespiratory fitness and provides insight into the etiology of exercise intolerance. Furthermore, CPET variables, such as peak oxygen consumption and submaximal variables, have prognostic value and may be used as meaningful endpoints in research studies. CPET is also useful in clinical research applications to assess the effect of pharmacologic or other interventions. Medical therapies to improve exercise tolerance in individuals with a Fontan circulation, such as pulmonary vasodilators, may modestly improve peak oxygen consumption. Exercise training focused on aerobic fitness and lower extremity strength may have a more consistent and larger impact on these measures of aerobic fitness. CPET is a valuable diagnostic and prognostic tool for those with a Fontan circulation. Newer ancillary assessments, such as noninvasive peripheral venous pressure monitoring and cardiac output measurements, hold promise to provide a more nuanced insight into the underlying pathophysiology.

Isosorbide DiNitrate Effect on Hemodynamic Profile, Liver Stiffness, and Exercise Tolerance in Fontan Circulation (The NEET Clinical Trial).

After Fontan operation, decreased venous capacitance and venoconstriction are adaptive mechanisms to maintain venous return and cardiac output. The consequent higher venous pressure may adversely impact end-organ function, exercise capacity and result in worse clinical outcomes. This pilot study evaluated the safety and effect of isosorbide dinitrate (ISDN), a venodilator, on exercise capacity, peripheral venous pressure (PVP), and liver stiffness in patients with Fontan circulation. In this prospective single-arm trial, 15 individuals with Fontan circulation were evaluated at baseline and after 4 weeks of therapeutic treatment with ISDN. Primary aims were to assess the safety of ISDN and the effect on maximal exercise. We also aimed to evaluate the effect of ISDN on ultrasound-assessed liver stiffness, markers of submaximal exercise, and PVP at rest and peak exercise. Repeated measures t-tests were used to assess change in variables of interest in response to ISDN. Mean age was 23.5 ± 9.2years (range 11.2-39.0years), and 10/15 (67%) were male. There was no statistically significant change in peak VO2 (1401 ± 428 to 1428 ± 436mL/min, p = 0.128), but VO2 at the anaerobic threshold increased (1087 ± 313 to 1115 ± 302mL/min, p = 0.03). ISDN was also associated with a lower peak exercise PVP (22.5 ± 4.5 to 20.6 ± 3.0mmHg, p = 0.015). Liver stiffness was lower with ISDN, though the difference was not statistically significant (2.3 ± 0.4 to 2.1 ± 0.5m/s, p = 0.079). Of the patients completing the trial, mild headache was common (67%), but there were no major adverse events. Treatment with ISDN for 4weeks is well-tolerated in patients with a Fontan circulation. ISDN is associated with an increase in VO2 at anaerobic threshold, lower peak PVP, and a trend toward lower liver stiffness. Larger, longer durationstudies will be necessary to define the impact of ISDN on clinical outcomes in the Fontan circulation.Clinical Trial Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT04297241.

Prognostic implications of post-discharge hemodynamic congestion assessed by peripheral venous pressure among patients discharged from acute heart failure

BackgroundCongestion is a major cause of hospitalization for heart failure (HF). Peripheral venous pressure (PVP) strongly correlates with right atrial pressure. We recently reported that high PVP at discharge portends a poor prognosis in patients hospitalized for HF. In the same population, we aimed to analyze changes in PVP after discharge and to evaluate prognostic implications of post-discharge PVP. MethodsPVP was measured at the forearm vein of 163 patients in the 1-month post-discharge follow-up visit. The primary outcome was a composite of cardiovascular death or re-hospitalization for HF after the 1-month follow-up visit up to 1 year after discharge. ResultsPost-discharge PVP correlated with jugular venous pressure, the inferior vena cava diameter, and brain-type natriuretic peptide levels. The cumulative incidence of the primary outcome event was significantly higher in patients with PVP above the median (6 mmHg) than in those with median PVP or lower (39.8% versus 16.9%, Log-rank P = 0.04). Age- and sex-adjusted risk of PVP per 1 mmHg for the primary outcome measure was significant (hazard ratio: 1.12 [95% confidence interval 1.03–1.21]). 35% of patients who had PVP ≤6 mmHg at discharge had PVP >6 mmHg at the 1-month follow-up. PVP significantly decreased from discharge to 1-month follow-up in patients without the primary outcome event (from 6 [4–10] to 6 [4–8] mmHg, P=0.01), but remained high in those with the primary outcome event (from 8 [5–11] to 7 [5–10.5] mmHg, P = 0.9). ConclusionsPVP measurements during the early post-discharge period may be useful to identify high risk patients.Trial registration number: UMIN000034279.

Abstract 15532: Pressure Measurement From a Peripheral Iv Correlates Well With Invasive Central Venous Pressure Measurement

Introduction: Despite its importance in cardiac patients, accurate central venous pressure (CVP) estimation remains a challenge. Noninvasive methods, such as jugular venous pressure measurement, are highly dependent on examiner experience, and the gold-standard invasive methods require procedures that carry risk of complication. Recent studies suggest that pressure measurement directly from a patient’s peripheral intravenous (IV) catheter, termed peripheral venous pressure (PVP), appears promising as an accurate and noninvasive method for CVP estimation. Methods: To be included in the study, patients were either receiving right heart catheterization (RHC) or had an existing pulmonary artery catheter (PAC) in place. CVP was measured using standard technique either during RHC or at bedside from the PAC. The same pressure tubing was then connecting to the patient’s existing IV, regardless of the location or catheter gauge, for measurement of the PVP. Results: Seventeen patients were prospectively enrolled. The majority (70.6%) had their CVP and PVP measured during RHC. In the overall cohort, 35.3% were on mechanical circulatory support, and 29.4% were on inotropes at the time of measurement. CVP and PVP measurements were significantly correlated with one another (Pearson’s r = 0.73, p &lt; 0.001; Figure 1A). Sensitivity analysis was performed to exclude one notable outlier, which strengthened the correlation (Pearson’s r = 0.91, p &lt; 0.001; Figure 1B). Conclusions: This data suggests that PVP is a promising and simple method for the noninvasive estimation of CVP.

Central Venous Pressure Waveform Analysis Predicts Perfusion in a Porcine Model of Endotoxemic Hypotension and Resuscitation

Introduction: Cardiac output (CO), a proxy for perfusion, is a critical measure during sepsis and resuscitation. The understudied venous system has nuanced physiology that confers valuable information. In this investigation, deconvolution of the central venous pressure (CVP) waveform by the fast Fourier transformation (FFT) algorithm is performed to derive a CO surrogate in a “sepsis-like” porcine model of endotoxemic hypotension and resuscitation. Methods: Nine pigs were anesthetized, catheterized and intubated. A lipopolysaccharides infusion protocol was employed to precipitate low systemic vascular resistance (SVR) hypotension. Four subsequent crystalloid boluses (10 cc/kg) were given, after which thermodilution-CO, CVP and the CVP waveform were collected, the latter undergoing FFT analysis. The amplitude of the fundamental frequency of CVP waveform’s cardiac wave (“f0-CVP”) was obtained. Mean CVP, f0-CVP and CO were plotted over the course of the boluses to determine whether f0-CVP tracked with CO better than CVP itself. Results: Distributive hypotension to a 25% mean arterial pressure decrement was achieved, with decreased SVR (918±227 [standard deviation] dynes/seconds/cm-5 vs 685±180 dynes/seconds/cm-5; P = 0.038). Over four boluses, slopes of linear regression lines of CVP (r2=0.27; P < 0.001), f0-CVP (r2=0.15; P = 0.01) and CO (r2=0.08; P = 0.06) were 0.447, 0.148 and 0.178, respectively, demonstrating that f0-CVP constitutes a more accurate CO surrogate than CVP. Conclusion: FFT analysis of CVP waveforms offers a novel paradigm to interpret readily obtainable hemodynamic information. It offers potential for real-time utility in assessing volume responsiveness in sepsis and resuscitation, while further offering potential translation to the less-invasive peripheral venous pressure waveform.

Changes in the Inferior Vena Cava Are More Sensitive Than Venous Pressure During Fluid Removal: A Proof-of-Concept Study

Congestion is central to the pathophysiology of heart failure (HF); thus, tracking congestion is crucial for the management of patients with HF. In this study we aimed to compare changes in inferior vena cava diameter (IVCD) with venous pressure following manipulation of volume status during ultrafiltration in patients with cardiac dysfunction. Patients with stable hemodialysis and with systolic or diastolic dysfunction were studied. Central venous pressure (CVP) and peripheral venous pressure (PVP) were measured before and after hemodialysis. IVCD and PVP were measured simultaneously just before dialysis, 3 times during dialysis and immediately after dialysis. Changes in IVCD and PVP were compared at each timepoint with ultrafiltration volumes. We analyzed 30 hemodialysis sessions from 20 patients. PVP was validated as a surrogate for CVP. Mean ultrafiltration volume was 2102 ± 667 mL. IVCD discriminated better ultrafiltration volumes ≤ 500 mL or ≤ 750 mL than PVP (AUC 0.80 vs 0.62, and 0.80 vs 0.56, respectively; both P< 0.01). IVCD appeared to track better ultrafiltration volume (P< 0.01) and hemoconcentration (P< 0.05) than PVP. Changes in IVCD were of greater magnitude than those of PVP (average change from predialysis: -58 ± 30% vs -28 ± 21%; P< 0.001). In patients undergoing ultrafiltration, changes in IVCD tracked changes in volume status better than venous pressure.