CLINICAL RESEARCH: HEART FAILURE
Utility of Impedance Cardiography for the Identification of Short-Term Risk of Clinical Decompensation in Stable Patients With Chronic Heart Failure
Milton Packer, MD, FACC*,*,
William T. Abraham, MD, FACC ,
Mandeep R. Mehra, MD, FACC ,
Clyde W. Yancy, MD, FACC*,
Christine E. Lawless, MD, FACC ,
Judith E. Mitchell, MD, FACC||,
Frank W. Smart, MD, FACC¶,
Rachel Bijou, MD, FACC#,
Christopher M. O’Connor, MD, FACC**,
Barry M. Massie, MD, FACC,
Ileana L. Pina, MD, FACC,
Barry H. Greenberg, MD, FACC,
James B. Young, MD, FACC||||,
Daniel P. Fishbein, MD, FACC¶¶,
Paul J. Hauptman, MD, FACC##,
Robert C. Bourge, MD, FACC***,
John E. Strobeck, MD, PhD, FACC,
Srinvivas Murali, MD, FACC,
Douglas Schocken, MD, FACC,
John R. Teerlink, MD, FACC,
Wayne C. Levy, MD, FACC¶¶,
Robin J. Trupp, MSN, RN*,
Marc A. Silver, MD, FACC|||||| for the Prospective Evaluation and Identification of Cardiac Decompensation by ICG Test (PREDICT) Study Investigators and Coordinators
* University of Texas Southwestern Medical Center, Dallas, Texas
Ohio State University Heart Center, Columbus, Ohio
University of Maryland School of Medicine, Baltimore, Maryland
DuPage Medical Group, Chicago, Illinois
|| SUNY Downstate Medical Center, New York, New York
¶ Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas
# Columbia-Presbyterian Medical Center, New York, New York
** Duke University Medical Center, Durham, North Carolina
San Francisco Veterans Administration Medical Center, San Francisco, California
Case Western Reserve University, Cleveland, Ohio
University of California, San Diego, San Diego, California
|||| Cleveland Clinic Foundation, Cleveland, Ohio
¶¶ University of Washington, Seattle, Washington
## St. Louis University, St. Louis, Missouri
*** University of Alabama, Birmingham, Alabama
Heart Lung Associates of America, Hawthorne, New Jersey
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
University of South Florida, Tampa, Florida
|||||| Advocate Christ Medical Center, Oak Lawn, Illinois
Manuscript received August 3, 2005;
revised manuscript received December 14, 2005,
accepted December 16, 2005.
* Reprint requests and correspondence: Dr. Milton Packer, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Room E5.506P, Dallas, Texas 75390-8822. (Email: Milton.Packer{at}UTSouthwestern.edu).
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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Abbreviations and Acronyms
| | HF = heart failure | | ICG = impedance cardiography | | LVET = left ventricular ejection time | | NYHA = New York Heart Association | | SI = stroke index | | TFC = thoracic fluid content | | TFCI = thoracic fluid content index | | VI = velocity index |
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