Thoracic Impedance Change Rates in Implantable Devices Related to Clinical Scenarios of Patients with Decompensated Heart Failure

2012 ◽  
Vol 18 (10) ◽  
pp. S160
Author(s):  
Noboru Oda ◽  
Yukiko Nakano ◽  
Hiroki Ikenaga ◽  
Yoshikazu Watanabe ◽  
Hiroshi Kawazoe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decompensated Heart Failure ◽  
Implantable Devices ◽  
Impedance Change ◽  
Thoracic Impedance ◽  
Clinical Scenarios

Thoracic Impedance Measured Via Implantable Devices Provides Advanced Warning of Signs and Symptoms of Worsening Heart Failure in Addition to Hospitalization

2006 ◽  
Vol 12 (6) ◽  
pp. S5
Author(s):  
Lisa D. Rathman ◽  
Jill L. Repoley ◽  
Deanna Dukes-Graves ◽  
Jon G. Echterling ◽  
Sherri S. Delgado ◽  
...  
Keyword(s):  
Heart Failure ◽  
Signs And Symptoms ◽  
Implantable Devices ◽  
Thoracic Impedance

Thoracic impedance as a therapeutic marker of acute decompensated heart failure

2014 ◽  
Vol 174 (3) ◽  
pp. 840-842 ◽  
Author(s):  
Yoshiyasu Aizawa ◽  
Seiji Takatsuki ◽  
Shin Kashimura ◽  
Yoshinori Katsumata ◽  
Takahiko Nishiyama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Thoracic Impedance

scholarly journals The Added Value of In-Hospital Tracking of the Efficacy of Decongestion Therapy and Prognostic Value of a Wearable Thoracic Impedance Sensor in Acutely Decompensated Heart Failure With Volume Overload: Prospective Cohort Study (Preprint)

2018 ◽  
Author(s):  
Christophe J P Smeets ◽  
Seulki Lee ◽  
Willemijn Groenendaal ◽  
Gabriel Squillace ◽  
Julie Vranken ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Fluid Balance ◽  
Volume Overload ◽  
Decompensated Heart Failure ◽  
Added Value ◽  
Thoracic Impedance ◽  
Fluid Status ◽  
All Cause Mortality

BACKGROUND Incomplete relief of congestion in acute decompensated heart failure (HF) is related to poor outcomes. However, congestion can be difficult to evaluate, stressing the urgent need for new objective approaches. Due to its inverse correlation with tissue hydration, continuous bioimpedance monitoring might be an effective method for serial fluid status assessments. OBJECTIVE This study aimed to determine whether in-hospital bioimpedance monitoring can be used to track fluid changes (ie, the efficacy of decongestion therapy) and the relationships between bioimpedance changes and HF hospitalization and all-cause mortality. METHODS A wearable bioimpedance monitoring device was used for thoracic impedance measurements. Thirty-six patients with signs of acute decompensated HF and volume overload were included. Changes in the resistance at 80 kHz (R<sub>80kHz</sub>) were analyzed, with fluid balance (fluid in/out) used as a reference. Patients were divided into two groups depending on the change in R<sub>80kHz</sub> during hospitalization: increase in R<sub>80kHz</sub> or decrease in R<sub>80kHz</sub>. Clinical outcomes in terms of HF rehospitalization and all-cause mortality were studied at 30 days and 1 year of follow-up. RESULTS During hospitalization, R<sub>80kHz</sub> increased for 24 patients, and decreased for 12 patients. For the total study sample, a moderate negative correlation was found between changes in fluid balance (in/out) and relative changes in R<sub>80kHz</sub> during hospitalization (rs=-0.51, <i>P</i>&lt;.001). Clinical outcomes at both 30 days and 1 year of follow-up were significantly better for patients with an increase in R<sub>80kHz</sub>. At 1 year of follow-up, 88% (21/24) of patients with an increase in R<sub>80kHz</sub> were free from all-cause mortality, compared with 50% (6/12) of patients with a decrease in R<sub>80kHz</sub> (<i>P</i>=.01); 75% (18/24) and 25% (3/12) were free from all-cause mortality and HF hospitalization, respectively (<i>P</i>=.01). A decrease in R<sub>80kHz</sub> resulted in a significant hazard ratio of 4.96 (95% CI 1.82-14.37, <i>P</i>=.003) on the composite endpoint. CONCLUSIONS The wearable bioimpedance device was able to track changes in fluid status during hospitalization and is a convenient method to assess the efficacy of decongestion therapy during hospitalization. Patients who do not show an improvement in thoracic impedance tend to have worse clinical outcomes, indicating the potential use of thoracic impedance as a prognostic parameter.

Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice

2021 ◽  
Author(s):  
Luca Baldetti ◽  
Matteo Pagnesi ◽  
Mario Gramegna ◽  
Alessandro Belletti ◽  
Alessandro Beneduce ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Output ◽  
Cardiogenic Shock ◽  
Acute Decompensated Heart Failure ◽  
Therapeutic Option ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Ventricular Afterload ◽  
Clinical Scenarios

Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion. Several pathophysiological features differ between myocardial infarction- and acute decompensated heart failure–related hypoperfusion, encompassing cardiogenic shock severity, filling status, systemic vascular resistances rise, and adaptation to chronic (if preexisting) left ventricular dysfunction. IABP combines a more substantial effect on left ventricular afterload with a modest increase in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise. The acute decompensated heart failure syndrome is characterized by exquisite afterload-sensitivity of cardiac output and may be an ideal setting for counterpulsation. Several hemodynamic variables have been shown to predict response to IABP within this scenario, potentially guiding appropriate patient selection. Finally, acute decompensated heart failure with hypoperfusion may frequently represent an end stage in the heart failure history: IABP may provide sufficient hemodynamic support and prompt end-organ function recovery in view of more definitive heart replacement therapies while preserving ambulation when used with a transaxillary approach.

scholarly journals The Added Value of In-Hospital Tracking of the Efficacy of Decongestion Therapy and Prognostic Value of a Wearable Thoracic Impedance Sensor in Acutely Decompensated Heart Failure With Volume Overload: Prospective Cohort Study

JMIR Cardio ◽  
10.2196/12141 ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. e12141 ◽  
Author(s):  
Christophe J P Smeets ◽  
Seulki Lee ◽  
Willemijn Groenendaal ◽  
Gabriel Squillace ◽  
Julie Vranken ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Fluid Balance ◽  
Volume Overload ◽  
Decompensated Heart Failure ◽  
Added Value ◽  
Thoracic Impedance ◽  
Fluid Status ◽  
All Cause Mortality

Background Incomplete relief of congestion in acute decompensated heart failure (HF) is related to poor outcomes. However, congestion can be difficult to evaluate, stressing the urgent need for new objective approaches. Due to its inverse correlation with tissue hydration, continuous bioimpedance monitoring might be an effective method for serial fluid status assessments. Objective This study aimed to determine whether in-hospital bioimpedance monitoring can be used to track fluid changes (ie, the efficacy of decongestion therapy) and the relationships between bioimpedance changes and HF hospitalization and all-cause mortality. Methods A wearable bioimpedance monitoring device was used for thoracic impedance measurements. Thirty-six patients with signs of acute decompensated HF and volume overload were included. Changes in the resistance at 80 kHz (R80kHz) were analyzed, with fluid balance (fluid in/out) used as a reference. Patients were divided into two groups depending on the change in R80kHz during hospitalization: increase in R80kHz or decrease in R80kHz. Clinical outcomes in terms of HF rehospitalization and all-cause mortality were studied at 30 days and 1 year of follow-up. Results During hospitalization, R80kHz increased for 24 patients, and decreased for 12 patients. For the total study sample, a moderate negative correlation was found between changes in fluid balance (in/out) and relative changes in R80kHz during hospitalization (rs=-0.51, P<.001). Clinical outcomes at both 30 days and 1 year of follow-up were significantly better for patients with an increase in R80kHz. At 1 year of follow-up, 88% (21/24) of patients with an increase in R80kHz were free from all-cause mortality, compared with 50% (6/12) of patients with a decrease in R80kHz (P=.01); 75% (18/24) and 25% (3/12) were free from all-cause mortality and HF hospitalization, respectively (P=.01). A decrease in R80kHz resulted in a significant hazard ratio of 4.96 (95% CI 1.82-14.37, P=.003) on the composite endpoint. Conclusions The wearable bioimpedance device was able to track changes in fluid status during hospitalization and is a convenient method to assess the efficacy of decongestion therapy during hospitalization. Patients who do not show an improvement in thoracic impedance tend to have worse clinical outcomes, indicating the potential use of thoracic impedance as a prognostic parameter.

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