Ultrasound Based Approach to Diagnosing Heart Failure
OHSU # 1395
- Antony Kim, SM.Medicine
Right ventricular (RV) function has prognostic significance in heart failure, and RV dysfunction has been shown to predict reduced exercise capacity and survival. Current non-invasive methods to evaluate RV function include echochardiography (the most common), MRI, high frequency thermodilution, contrast ventriculography, and radionucleotide entriculography. However, none of these techniques have proven to be a reliable and validated method for determining RV function.
OHSU has a developed a novel, non-invasive, ultrasound image software analysis predictive model called the NICHE (non-invasive cardiac hemodynamic evaluation) algorithm for determining RV function.
Assessment of the right-sided intracardiac pressures is vital in estimating right heart function and volume status in patients with acute and chronic heart failure (CHF). The current standard and most direct method for measurement of intracardiac pressures is right-heart catheterization (RHC). This procedure is invasive and therefore poses risks, especially in ill patient populations. RHC is also often cumbersome and expensive and, being invasive, it is impractical to perform serial RHC procedures. Thus, RHC is not a suitable technique for providing immediate up-to-date clinical information necessary for management of patients on a day-to-day basis.
A non-invasive alternative to RHC is the commonly used physical examination metric for right-sided pressure assessment called the jugular venous pulsation (JVP). Traditionally, the assumption has been that the JVP estimation reliably predicts the central venous pressure (CVP), which in turn is considered to be relatively equivalent to right atrial pressure (RA), a marker of circulating volume and RV function. However, the JVP estimation is limited by a number of factors such as the subjectís body habitus, neck position, and operator interpretation and skill levels- all factors that affect the reliability of this metric.
NICHE can provide assessment of right internal jugular (IJ) vein characteristics that correlate with RHC-measured intracardiac pressures, thereby offering a reliable and non-invasive method for determining RV function
PCT Publication No. WO/2009/111789
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