Non-invasive haemodynamic and fluid assessment using NiCaS for therapeutic optimization in patients with chronic heart failure
E Salerno, I Fumarulo, B Garramone, M Vaccarella, F Burzotta, N AspromonteAbstract
Background
Acute and chronic heart failure (HF) are characterized by complex haemodynamic alterations and systemic congestion, which represent both a cause and consequence of disease progression. Accurate assessment of intravascular volume status is crucial for risk stratification and therapeutic decision-making, particularly in patients requiring repeated diuretic adjustments.Currently, the gold standard for haemodynamic assessment remains invasive right heart catheterization, which is not suitable for routine or serial evaluations.NiCaS (Non-Invasive Cardiac System) is a novel technology based on regional bioimpedance that allows non-invasive assessment of cardiac haemodynamic and total body fluid content.
Purpose
To evaluate the clinical usefulness of NiCaS-derived haemodynamic and fluid parameters in guiding therapeutic management of patients with chronic heart failure undergoing intravenous diuretic treatment.
Methods
We conducted a prospective observational analysis in 60 patients with chronic heart failure referred to a Day Hospital for scheduled intravenous diuretic therapy. All patients underwent non-invasive haemodynamic assessment using NiCaS at admission and after 4–5 hours of intravenous diuretic infusion, prior to discharge. Measured parameters included stroke volume(SV), stroke index(SI), cardiac output(CO), cardiac index(CI), total body water(TBW), total peripheral resistance(TPR), cardiac power index(CPI), and Granov–Goor index(GGI). NiCaS data were integrated with clinical evaluation and laboratory findings to individualize diuretic therapy.
Results
Sixty patients were analyzed (44 HFrEF, 9 HFmrEF, 7 HFpEF). The mean oral home dose of furosemide was 195 mg/day. An 83-year-old obese male patient with ischemic HFpEF was analyzed.Baseline NiCaS measurements showed: SV 61.2 mL,SI 35.6 mL/m²,CO 4.7 L/min,CI 2.8 L/min/m²,TBW 38.4 kg (55.9% of body weight),TPR 1468 dyn·s·cm⁻⁵, and CPI 0.51 W/m². Following intravenous diuretic administration, a modest reduction in total body water was observed (from 38.4 kg [55.9%] to 37.9 kg [55.2%]), while other haemodynamic parameters remained largely unchanged. Importantly, NiCaS assessment influenced therapeutic decision-making beyond clinical evaluation alone, allowing identification of patients in whom diuretic intensification would have been inappropriate despite clinical signs of congestion, as well as patients with occult fluid overload despite minimal symptoms.
Conclusions
Non-invasive haemodynamic and fluid assessment using NiCaS represents a valuable tool for therapeutic optimization in patients with chronic heart failure.By providing objective and reproducible data on volume status and cardiac function, NiCaS may support personalized diuretic management, improve detection of subclinical congestion, and potentially reduce inappropriate treatment decisions.Its non-invasive nature and ease of use make it suitable for routine and serial assessment in outpatient and day-hospital HF management pathways.NiCaS-guided therapeutic pathwayFor image description, please refer to the figure legend and surrounding text.Haemodynamic status report of a patientFor image description, please refer to the figure legend and surrounding text.