Utility of Impedance Cardiography for the Identification of Short-Term Risk of Clinical Decompensation in Stable Patients With Chronic Heart Failure

Milton Packer, William T. Abraham, Mandeep R. Mehra, Clyde W. Yancy, Christine E. Lawless, Judith E. Mitchell, Frank W. Smart, Rachel Bijou, Christopher M. O'Connor, Barry M. Massie, Ileana L. Pina, Barry H. Greenberg, James B. Young, Daniel P. Fishbein, Paul Hauptman, Robert C. Bourge, John E. Strobeck, Srinvivas Murali, Douglas Schocken, John R. Teerlink & 3 others Wayne C. Levy, Robin J. Trupp, Marc A. Silver

Research output: Contribution to journalArticle

141 Citations (Scopus)

Abstract

Objectives: 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.

Original languageEnglish (US)
Pages (from-to)2245-2252
Number of pages8
JournalJournal of the American College of Cardiology
Volume47
Issue number11
DOIs
StatePublished - Jun 6 2006
Externally publishedYes

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Impedance Cardiography
Heart Failure
Hospitalization
Thorax
Blood Pressure
Electric Impedance
Emergencies
Multivariate Analysis
Hemodynamics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Utility of Impedance Cardiography for the Identification of Short-Term Risk of Clinical Decompensation in Stable Patients With Chronic Heart Failure. / Packer, Milton; Abraham, William T.; Mehra, Mandeep R.; Yancy, Clyde W.; Lawless, Christine E.; Mitchell, Judith E.; Smart, Frank W.; Bijou, Rachel; O'Connor, Christopher M.; Massie, Barry M.; Pina, Ileana L.; Greenberg, Barry H.; Young, James B.; Fishbein, Daniel P.; Hauptman, Paul; Bourge, Robert C.; Strobeck, John E.; Murali, Srinvivas; Schocken, Douglas; Teerlink, John R.; Levy, Wayne C.; Trupp, Robin J.; Silver, Marc A.

In: Journal of the American College of Cardiology, Vol. 47, No. 11, 06.06.2006, p. 2245-2252.

Research output: Contribution to journalArticle

Packer, M, Abraham, WT, Mehra, MR, Yancy, CW, Lawless, CE, Mitchell, JE, Smart, FW, Bijou, R, O'Connor, CM, Massie, BM, Pina, IL, Greenberg, BH, Young, JB, Fishbein, DP, Hauptman, P, Bourge, RC, Strobeck, JE, Murali, S, Schocken, D, Teerlink, JR, Levy, WC, Trupp, RJ & Silver, MA 2006, 'Utility of Impedance Cardiography for the Identification of Short-Term Risk of Clinical Decompensation in Stable Patients With Chronic Heart Failure', Journal of the American College of Cardiology, vol. 47, no. 11, pp. 2245-2252. https://doi.org/10.1016/j.jacc.2005.12.071
Packer, Milton ; Abraham, William T. ; Mehra, Mandeep R. ; Yancy, Clyde W. ; Lawless, Christine E. ; Mitchell, Judith E. ; Smart, Frank W. ; Bijou, Rachel ; O'Connor, Christopher M. ; Massie, Barry M. ; Pina, Ileana L. ; Greenberg, Barry H. ; Young, James B. ; Fishbein, Daniel P. ; Hauptman, Paul ; Bourge, Robert C. ; Strobeck, John E. ; Murali, Srinvivas ; Schocken, Douglas ; Teerlink, John R. ; Levy, Wayne C. ; Trupp, Robin J. ; Silver, Marc A. / Utility of Impedance Cardiography for the Identification of Short-Term Risk of Clinical Decompensation in Stable Patients With Chronic Heart Failure. In: Journal of the American College of Cardiology. 2006 ; Vol. 47, No. 11. pp. 2245-2252.
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title = "Utility of Impedance Cardiography for the Identification of Short-Term Risk of Clinical Decompensation in Stable Patients With Chronic Heart Failure",
abstract = "Objectives: 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.",
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T1 - Utility of Impedance Cardiography for the Identification of Short-Term Risk of Clinical Decompensation in Stable Patients With Chronic Heart Failure

AU - Packer, Milton

AU - Abraham, William T.

AU - Mehra, Mandeep R.

AU - Yancy, Clyde W.

AU - Lawless, Christine E.

AU - Mitchell, Judith E.

AU - Smart, Frank W.

AU - Bijou, Rachel

AU - O'Connor, Christopher M.

AU - Massie, Barry M.

AU - Pina, Ileana L.

AU - Greenberg, Barry H.

AU - Young, James B.

AU - Fishbein, Daniel P.

AU - Hauptman, Paul

AU - Bourge, Robert C.

AU - Strobeck, John E.

AU - Murali, Srinvivas

AU - Schocken, Douglas

AU - Teerlink, John R.

AU - Levy, Wayne C.

AU - Trupp, Robin J.

AU - Silver, Marc A.

PY - 2006/6/6

Y1 - 2006/6/6

N2 - Objectives: 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.

AB - Objectives: 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.

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