Correlation of impedance cardiography with invasive hemodynamic measurements in patients with advanced heart failure: The BioImpedance CardioGraphy (BIG) substudy of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) Trial

Sandeep A. Kamath, Mark H. Drazner, Gudaye Tasissa, Joseph G. Rogers, Lynne Warner Stevenson, Clyde W. Yancy

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Abstract

Background: Impedance cardiography (ICG) is a noninvasive modality that uses changes in impedance across the thorax to assess hemodynamic parameters, including cardiac output (CO). The utility of ICG in patients hospitalized with heart failure is uncertain. Methods: The BioImpedance CardioGraphy in Advanced Heart Failure study was a prospective substudy of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness. A total of 170 subjects underwent blinded ICG measurements using BioZ (CardioDynamics, San Diego, CA); of these, 82 underwent right heart catheterization. We compared ICG with invasively measured hemodynamics by simple correlation and compared overall ICG hemodynamic profiles ("wet" [thoracic fluid content ≥47/kOhm in men and ≥37/kOhm in women] and "cold" [cardiac index ≤2.2 L min-1m-2) versus those determined by invasive measurements (wet [pulmonary capillary wedge pressure ≥22 mm Hg] and cold [cardiac index ≤2.2 L min-1m-2). We also determined whether ICG measurements were associated with subsequent death or hospitalization within 6 months. Results: There was modest correlation between ICG and invasively measured CO (r = 0.4 to 0.6 on serial measurement). Thoracic fluid content measured by ICG was not a reliable measure of pulmonary capillary wedge pressure. There was poor agreement between ICG and invasively measured hemodynamic profiles (κ ≤0.1). No ICG variable alone or in combination was associated with outcome. Conclusions: In hospitalized patients with advanced heart failure, ICG provides some information about CO but not left-sided filling pressures. Impedance cardiography did not have prognostic utility in this patient population.

Original languageEnglish (US)
Pages (from-to)217-223
Number of pages7
JournalThe American Heart Journal
Volume158
Issue number2
DOIs
StatePublished - Aug 2009

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Swan-Ganz Catheterization
Impedance Cardiography
Heart Failure
Hemodynamics
Cardiac Output
Pulmonary Wedge Pressure
Thorax
Pulmonary Edema
Cardiac Catheterization
Electric Impedance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{ed3acd2212b04419bd5e44c8b2886137,
title = "Correlation of impedance cardiography with invasive hemodynamic measurements in patients with advanced heart failure: The BioImpedance CardioGraphy (BIG) substudy of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) Trial",
abstract = "Background: Impedance cardiography (ICG) is a noninvasive modality that uses changes in impedance across the thorax to assess hemodynamic parameters, including cardiac output (CO). The utility of ICG in patients hospitalized with heart failure is uncertain. Methods: The BioImpedance CardioGraphy in Advanced Heart Failure study was a prospective substudy of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness. A total of 170 subjects underwent blinded ICG measurements using BioZ (CardioDynamics, San Diego, CA); of these, 82 underwent right heart catheterization. We compared ICG with invasively measured hemodynamics by simple correlation and compared overall ICG hemodynamic profiles ({"}wet{"} [thoracic fluid content ≥47/kOhm in men and ≥37/kOhm in women] and {"}cold{"} [cardiac index ≤2.2 L min-1m-2) versus those determined by invasive measurements (wet [pulmonary capillary wedge pressure ≥22 mm Hg] and cold [cardiac index ≤2.2 L min-1m-2). We also determined whether ICG measurements were associated with subsequent death or hospitalization within 6 months. Results: There was modest correlation between ICG and invasively measured CO (r = 0.4 to 0.6 on serial measurement). Thoracic fluid content measured by ICG was not a reliable measure of pulmonary capillary wedge pressure. There was poor agreement between ICG and invasively measured hemodynamic profiles (κ ≤0.1). No ICG variable alone or in combination was associated with outcome. Conclusions: In hospitalized patients with advanced heart failure, ICG provides some information about CO but not left-sided filling pressures. Impedance cardiography did not have prognostic utility in this patient population.",
author = "Kamath, {Sandeep A.} and Drazner, {Mark H.} and Gudaye Tasissa and Rogers, {Joseph G.} and Stevenson, {Lynne Warner} and Yancy, {Clyde W.}",
year = "2009",
month = "8",
doi = "10.1016/j.ahj.2009.06.002",
language = "English (US)",
volume = "158",
pages = "217--223",
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TY - JOUR

T1 - Correlation of impedance cardiography with invasive hemodynamic measurements in patients with advanced heart failure

T2 - The BioImpedance CardioGraphy (BIG) substudy of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) Trial

AU - Kamath, Sandeep A.

AU - Drazner, Mark H.

AU - Tasissa, Gudaye

AU - Rogers, Joseph G.

AU - Stevenson, Lynne Warner

AU - Yancy, Clyde W.

PY - 2009/8

Y1 - 2009/8

N2 - Background: Impedance cardiography (ICG) is a noninvasive modality that uses changes in impedance across the thorax to assess hemodynamic parameters, including cardiac output (CO). The utility of ICG in patients hospitalized with heart failure is uncertain. Methods: The BioImpedance CardioGraphy in Advanced Heart Failure study was a prospective substudy of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness. A total of 170 subjects underwent blinded ICG measurements using BioZ (CardioDynamics, San Diego, CA); of these, 82 underwent right heart catheterization. We compared ICG with invasively measured hemodynamics by simple correlation and compared overall ICG hemodynamic profiles ("wet" [thoracic fluid content ≥47/kOhm in men and ≥37/kOhm in women] and "cold" [cardiac index ≤2.2 L min-1m-2) versus those determined by invasive measurements (wet [pulmonary capillary wedge pressure ≥22 mm Hg] and cold [cardiac index ≤2.2 L min-1m-2). We also determined whether ICG measurements were associated with subsequent death or hospitalization within 6 months. Results: There was modest correlation between ICG and invasively measured CO (r = 0.4 to 0.6 on serial measurement). Thoracic fluid content measured by ICG was not a reliable measure of pulmonary capillary wedge pressure. There was poor agreement between ICG and invasively measured hemodynamic profiles (κ ≤0.1). No ICG variable alone or in combination was associated with outcome. Conclusions: In hospitalized patients with advanced heart failure, ICG provides some information about CO but not left-sided filling pressures. Impedance cardiography did not have prognostic utility in this patient population.

AB - Background: Impedance cardiography (ICG) is a noninvasive modality that uses changes in impedance across the thorax to assess hemodynamic parameters, including cardiac output (CO). The utility of ICG in patients hospitalized with heart failure is uncertain. Methods: The BioImpedance CardioGraphy in Advanced Heart Failure study was a prospective substudy of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness. A total of 170 subjects underwent blinded ICG measurements using BioZ (CardioDynamics, San Diego, CA); of these, 82 underwent right heart catheterization. We compared ICG with invasively measured hemodynamics by simple correlation and compared overall ICG hemodynamic profiles ("wet" [thoracic fluid content ≥47/kOhm in men and ≥37/kOhm in women] and "cold" [cardiac index ≤2.2 L min-1m-2) versus those determined by invasive measurements (wet [pulmonary capillary wedge pressure ≥22 mm Hg] and cold [cardiac index ≤2.2 L min-1m-2). We also determined whether ICG measurements were associated with subsequent death or hospitalization within 6 months. Results: There was modest correlation between ICG and invasively measured CO (r = 0.4 to 0.6 on serial measurement). Thoracic fluid content measured by ICG was not a reliable measure of pulmonary capillary wedge pressure. There was poor agreement between ICG and invasively measured hemodynamic profiles (κ ≤0.1). No ICG variable alone or in combination was associated with outcome. Conclusions: In hospitalized patients with advanced heart failure, ICG provides some information about CO but not left-sided filling pressures. Impedance cardiography did not have prognostic utility in this patient population.

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DO - 10.1016/j.ahj.2009.06.002

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