Utility of impedance cardiography for the identification of short-term risk of clinical decompensation in stable patients with chronic heart failure.
OBJECTIVE
This study sought to assess the potential utility of impedance cardiography (ICG) in predicting clinical deterioration in ambulatory patients with heart failure (HF).


BACKGROUND
Impedance cardiography uses changes in thoracic electrical impedance to estimate hemodynamic variables, but its ability to predict clinical events has not been evaluated.


METHODS
We prospectively evaluated 212 stable patients with HF and a recent episode of clinical decompensation who underwent serial clinical evaluation and blinded ICG testing every 2 weeks for 26 weeks and were followed up for the occurrence of death or worsening HF requiring hospitalization or emergent care.


RESULTS
During the study, 59 patients experienced 104 episodes of decompensated HF (16 deaths, 78 hospitalizations, and 10 emergency visits). Multivariate analysis identified 6 clinical and ICG variables that independently predicted an event within 14 days of assessment. These included three clinical variables (visual analog score, New York Heart Association functional class, and systolic blood pressure) and three ICG parameters (velocity index, thoracic fluid content index, and left ventricular ejection time). The three ICG parameters combined into a composite score was a powerful predictor of an event during the next 14 days (p = 0.0002). Visits with a high-risk composite score had 2.5 times greater likelihood and those with a low-risk score had a 70% lower likelihood of a near-term event compared with visits at intermediate risk.


CONCLUSIONS
These results suggest that when performed at regular intervals in stable patients with HF with a recent episode of clinical decompensation, ICG can identify patients at increased near-term risk of recurrent decompensation.
Packer
Milton
M
University of Texas Southwestern Medical Center, Dallas, Texas 75390-8822, USA. Milton.Packer@UTSouthwestern.edu
Abraham
William T
WT
Mehra
Mandeep R
MR
Yancy
Clyde W
CW
Lawless
Christine E
CE
Mitchell
Judith E
JE
Smart
Frank W
FW
Bijou
Rachel
R
O'Connor
Christopher M
CM
Massie
Barry M
BM
Pina
Ileana L
IL
Greenberg
Barry H
BH
Young
James B
JB
Fishbein
Daniel P
DP
Hauptman
Paul J
PJ
Bourge
Robert C
RC
Strobeck
John E
JE
Murali
Srinvivas
S
Schocken
Douglas
D
Teerlink
John R
JR
Levy
Wayne C
WC
Trupp
Robin J
RJ
Silver
Marc A
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000150:complications* / Q000175:diagnosis*; D002307:Cardiography, Impedance; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods