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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

View larger version (30K): [in a new window]   Figure 1 All patient visits were placed into one of four hemodynamic quadrants according to values of stroke index and thoracic fluid content. For each quadrant, the number of visits fulfilling the criteria for the quadrant, the number of heart failure events within 14 days of these visits, and the event rates (and associated 95% confidence intervals) are shown.

View larger version (19K): [in a new window]   Figure 2 Thoracic fluid content describes inverse value of the level of baseline impedance (Z) within the thorax, from which the Z waveform originates. Velocity index describes the maximum deflection of the first derivative of the Z waveform, shown as the Z/t waveform (C point). Pre-ejection period (PEP) is measured from ventricular depolarization (Q point) to aortic valve opening (B point). Left ventricular ejection time (LVET) is measured from aortic valve opening (B point) to aortic valve closure (X point). Pulmonic valve closure (Y point) and mitral valve closure (O point) can also be identified. ECG = electrocardiogram.