Objectives

At the present time, the criteria for diagnosis of heart failure (HF) are non-specific. The symptoms or findings of HF are at the end of the disease process and there are many clinical confounders. especially if these patients had concomitant severe chronic obstructive pulmonary disease (COPD), cirrhosis or chronic kidney disease (CKD) or while on respirator. There is a need for a specific test which can detect fluid overload (the precursor of HF) and predict the outcome of near future even the patient is clinically asymptomatic

Methods

Patients with confirmed diagnosis of HF now in good recovery and asymptomatic were enrolled. The patient might have comorbidities (chronic obstructive lung disease cirrhosis, chronic kidney disease). All patients underwent physical exam (PE), Chest XR PLUS an ultrasound study checking the size and expansion of the femoral vein (FV) (SEFV). The image was the coronal plane proximal to the bifurcation of the superficial (SFA) and deep femoral artery (PFA). The principle of this test is that the volume of blood going through the common femoral artery (CFA) and returning through the common FV should be the same. In normal condition, the FV is a little larger than the FA. In patient with significant fluid overload, the femoral vein is much larger than the common femoral artery and it does not expand following cough. As the femoral vein is filled with blood, it takes more of a round shape. These asymptomatic patients were divided into 2 groups: group A: with enlarged FV and group B: without enlarged FV. They were followed up for 12 months for relapse of acute on chronic HF and mortality

Results

Altogether 80 patients were enrolled. 40 asymptomatic patients with enlarged FV and 40 asymptomatic patients without enlarged FV. These patients were followed for one year. 90% of patients group B did not require hospitalization compared to 30% in the group A (p<0.05). There was no mortality in group B while it was 20% in group A.

Conclusions

The SEFV test was more accurate in confirming the fluid status and predating the prognosis of asymptomatic HF patients especially patient with complex co-morbidities. With treatment under the guidance of SEFV, the rate of hospitalization and mortality were much lower. Long term and randomized trials are needed to confirm the above findings.