title: Value of impedance cardiography in patients studied for pulmonary hypertension.
abstract: The aim of this study was to evaluate the accuracy and precision of impedance cardiography as a method for noninvasive hemodynamic evaluation of patients with pulmonary hypertension (PH). We performed a prospective and blinded study of patients who underwent right heart catheterization (RHC) for evaluation of known or presumed PH at the University of Florida from August 2009 to March 2010. The cohort consisted of a total of 39 patients (age = 57 ± 14 years, 87% women) with presumed (23%) or confirmed PH (77%) of different etiologies. Patients underwent RHC and impedance cardiography using the PhysioFlow PF-05. The PhysioFlow PF-05 measures cardiac output (CO) and LV end-diastolic volume (LVEDV), among other parameters. The median pulmonary artery pressure was 36 (IQR 26-56) mmHg. The CO (mean ± SD) by thermodilution (CO-T) and by impedance cardiography (CO-IC) was 5.9 ± 2.2 and 5.6 ± 1.5 L/min, respectively. Bland-Altman analysis of CO-T versus CO-IC revealed a mean of 0.3 L/min (95% LoA: -2.2 to +2.8). In patients with PH, the correlation of CO-T and CO-IC had a mean of 0.4 L/min (95% LoA: 2.9 and -2.2). Pulmonary artery occlusion pressure (PAOP) correlated with LVEDV (R (2) = 0.2, p = 0.005). By ROC analysis, EDV ≥ 200 ml had a sensitivity of 53% and a specificity of 86% for PAOP > 15 mmHg (AUC = 0.78). In patients with PH, impedance cardiography had good accuracy and fair precision for CO determination when compared with thermodilution. Impedance cardiography may provide information about the preload status and has the potential to become a cost-effective and noninvasive method for the follow-up of patients with PH.
authors: Division of Pulmonary, Critical Care and Sleep Medicine, Cleveland Clinic, 9500 Euclid Avenue A-90, Cleveland, OH 44195, USA. tonella@ccf.org
authors: Adriano R
authors: AR
authors: Tonelli
authors: Hassan
authors: H
authors: Alnuaimat
authors: Ning
authors: N
authors: Li
authors: Robin
authors: R
authors: Carrie
authors: Kamal K
authors: KK
authors: Mubarak
references: Congest Heart Fail. 2004 Mar-Apr;10(2 Suppl 2):7-10
references: 15073478
references: Am J Cardiol. 2002 Apr 15;89(8):993-5
references: 11950446
references: Singapore Med J. 2006 Nov;47(11):967-70
references: 17075665
references: Nurs Res. 1993 Jul-Aug;42(4):228-33
references: 8337161
references: Acad Emerg Med. 2003 Jun;10(6):669-80
references: 12782531
references: J Clin Monit Comput. 1999 Feb;15(2):85-91
references: 12578081
references: Crit Care Med. 2000 Mar;28(3):698-702
references: 10752817
references: Respir Med. 2010 Apr;104(4):481-96
references: 20004088
references: Eur J Appl Physiol. 2000 Jul;82(4):313-20
references: 10958374
references: Medicina (Kaunas). 2006;42(6):464-71
references: 16816540
references: Circulation. 2009 Apr 28;119(16):2250-94
references: 19332472
references: Am Heart J. 2009 Aug;158(2):217-23
references: 19619697
references: Chest. 2003 Jun;123(6):2028-33
references: 12796185
references: Cardiol J. 2007;14(2):115-26
references: 18651447
references: J Am Coll Cardiol. 2009 Jun 30;54(1 Suppl):S55-S66
references: 19555859
references: AACN Clin Issues. 2003 May;14(2):240-50
references: 12819460
references: Eur J Appl Physiol. 2001 Aug;85(3-4):202-7
references: 11560071
references: Proc Am Thorac Soc. 2008 Jul 15;5(5):617-22
references: 18625754
references: Respir Med. 2010 Nov;104(11):1588-607
references: 20810261
references: J Cardiothorac Vasc Anesth. 2002 Feb;16(1):8-14
references: 11854871
references: Chest. 1998 Dec;114(6):1643-52
references: 9872201
references: Chest. 2006 Oct;130(4):934-6
references: 17035418
references: Chest. 2011 Jan;139(1):115-21
references: 20595458
references: Nurs Res. 2006 Jul-Aug;55(4):283-91
references: 16849981
references: Am J Crit Care. 2004 Nov;13(6):469-79
references: 15568652
references: J Appl Physiol (1985). 2006 Jun;100(6):2031-40
references: 16455814
references: Clin Invest Med. 1992 Apr;15(2):103-12
references: 1534291
references: Eur J Intern Med. 2008 Oct;19(6):399-405
references: 18848172
references: Anesthesiology. 1986 Jun;64(6):764-70
references: 3487261
references: Anesthesiology. 1990 May;72(5):781-3
references: 2339794
references: Am Heart J. 1997 Sep;134(3):450-5
references: 9327701