title: Device-based impedance measurement is a useful and accurate tool for direct assessment of intrathoracic fluid accumulation in heart failure.
abstract: OBJECTIVE
  Heart failure patients are often equipped with implanted devices and are frequently hospitalized due to volume overload. Reliable prediction of imminent fluid congestion has the potential to provide early detection of cardiac decompensation and therefore might be capable of enhancing therapy management. We investigated whether implant-based impedance (Z) measurement is closely correlated with directly assessed extravascular lung water and might thus be useful for patient monitoring.
  
  
  RESULTS
  In sheep, pulmonary fluid congestion was induced. Continuous haemodynamic monitoring was performed and extravascular lung water index (EVLWI) assessed. An implanted device with a right ventricular lead measured Z using different electrode configurations. All animals developed gradual pulmonary fluid accumulation leading to inclining lung oedema: EVLWI did increase from 9.5 +/- 1 to 21.1 +/- 5.1 mL/kg (+127%). A concomitant decrease of Z by up to 23%, depending on the electrode configuration, was observed and regression analysis between Z and EVLWI yielded a significant inverse correlation.
  
  
  CONCLUSIONS
  Changes of Z show a strong inverse correlation with changes of directly measured EVLWI. This allows the application of Z as a measure of intrathoracic fluid status and has the potential to optimize patient care, especially in the context of evolving telemedicine concepts.
authors.affiliation: Medizinische Klinik und Poliklinik I, Universitätsklinikum, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Becher
authors.forename: Susann G
authors.initials: SG
authors.lastname: Kaufmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Paule
authors.forename: Bernhard
authors.initials: B
authors.lastname: Fahn
authors.forename: Olaf
authors.initials: O
authors.lastname: Skerl
authors.forename: Wolfgang R
authors.initials: WR
authors.lastname: Bauer
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.forename: Sebastian K G
authors.initials: SK
authors.lastname: Maier
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000502:physiology; D002307:Cardiography, Impedance / Q000295:instrumentation*; D003911:Dextrans / Q000009:adverse effects; D004195:Disease Models, Animal; D015633:Extravascular Lung Water / Q000502:physiology*; D006333:Heart Failure / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D009638:Norepinephrine / Q000009:adverse effects; D011654:Pulmonary Edema / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D012756:Sheep; D017216:Telemedicine / Q000295:instrumentation
chemical_list: D003911:Dextrans; D009638:Norepinephrine