Non-Invasive Venous waveform Analysis (NIVA) correlates with pulmonary capillary wedge pressure (PCWP) and predicts 30-day admission in heart failure patients undergoing right heart catheterization: NIVA Scores correlate with PCWP and predicts 30-day admission.

Abstract

BACKGROUND\nHeart failure is the leading cause of hospitalization in the elderly and readmission is common. Clinical indicators of congestion may not precede acute congestion with enough time to prevent hospital admission for heart failure. Thus, there is a large and unmet need for accurate non-invasive assessment of congestion. Non-Invasive Venous waveform Analysis in heart failure (NIVAHF) is a novel, non-invasive technology that monitors intravascular volume status and hemodynamic congestion. The objective of this study was to determine the correlation of NIVAHF with pulmonary capillary wedge pressure (PCWP) and the ability of NIVAHF to predict 30-day admission after right heart catheterization (RHC).\n\n\nMETHODS\nThe prototype NIVAHF device was compared to PCWP in 106 subjects undergoing RHC. The NIVAHF algorithm was developed and trained to estimate PCWP. NIVA Scores and central hemodynamic parameters [(PCWP, pulmonary artery diastolic pressure (PAD), and cardiac output (CO)] were evaluated in 84 patients undergoing outpatient RHC. Receiver Operating Characteristic (ROC) curves were used to determine whether a NIVA Score predicted 30-day hospital admission.\n\n\nRESULTS\nThe NIVA Score demonstrated a positive correlation with PCWP (r=0.92, n=106, p<0.0001). NIVA Score at time of hospital discharge predicted 30-day admission with an AUC of 0.84, a NIVA Score >18 predicted admission with a sensitivity of 91% and specificity of 56%. Residual analysis suggested that no single patient demographic confounded the predictive accuracy of the NIVA Score.\n\n\nCONCLUSIONS\nNIVAHF is a non-invasive monitoring technology that is designed to provide an estimate of PCWP. A NIVA Score >18 indicated increased risk for 30-day hospital admission. This non-invasive measurement has potential for guiding decongestive therapy and prevention of hospital admission in heart failure patients.