Current Cardiology Reports

, Volume 8, Issue 3, pp 180–186 | Cite as

Impedance cardiography: More questions than answers

Abstract

Thoracic electrical bioimpedance, also known as impedance cardiography (ICG), is a noninvasive method to obtain hemodynamic measurements, including cardiac output. Recently, there has been a flurry of reports on the clinical use of ICG. Authors have suggested that ICG measurements are useful for a myriad of situations, including diagnosis of heart failure, monitoring of a patient’s clinical status, and assisting in medicine titration decisions. However, data continue to suggest poor correlation between current generation ICG devices and invasive measurements of cardiac output, especially in heart failure patients. ICG is also not able to accurately measure left ventricular filling pressures. There are limited data demonstrating any improved outcomes using ICG in the clinical setting. Given the available data, ICG use should be limited to the research setting.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Osypka MJ, Bernstein DP: Electrophysiologic principles and theory of stroke volume determination by thoracic electrical bioimpedance. AACN Clin Issues 1999, 10:385–395. A fairly technical article that details the development of ICG theory and contains an appendix on basic electrical theory.PubMedCrossRefGoogle Scholar
  2. 2.
    van der Meer BJ, Woltjer HH, Sousman AM, et al.: Impedance cardiography. Importance of the equation and the electrode configuration. Intensive Care Med 1996, 22:1120–1124.PubMedCrossRefGoogle Scholar
  3. 3.
    Kubicek WG, Karnegis JN, Patterson RP, et al.: Development and evaluation of an impedance cardiac output system. Aerosp Med 1966, 37:1208–1212.PubMedGoogle Scholar
  4. 4.
    Balestra B, Malacrida R, Leonardi L, et al.: Esophageal electrodes allow precise assessment of cardiac output by bioimpedance. Crit Care Med 1992, 20:62–67.PubMedCrossRefGoogle Scholar
  5. 5.
    Woltjer HH, Bogaard HJ, Scheffer GJ, et al.: Standardization of non-invasive impedance cardiography for assessment of stroke volume: comparison with thermodilution. Br J Anaesth 1996, 77:748–752.PubMedGoogle Scholar
  6. 6.
    Sramek BB, Rose DM, Miyamoto A: Stroke volume equation with a linear base impedance model and its accuracy as compared to thermodilution and magnetic flowmeter techniques in humans and animals. Proceedings of the Sixth International Conference on Electrical Bioimpedance. Zadar, Yugoslovia; September 12–14, 1983.Google Scholar
  7. 7.
    Bernstein DP: New stroke volume equation for thoracic electrical bioimpedance: theory and rationale. Crit Care Med 1986, 14:904–909.PubMedCrossRefGoogle Scholar
  8. 8.
    Raaijmakers E, Faes TJ, Scholten RJ, et al.: A meta-analysis of three decades of validating thoracic impedance cardiography. Crit Care Med 1999, 27:1203–1213. Meta-analysis from 1999 summarizing data available at that time.PubMedCrossRefGoogle Scholar
  9. 9.
    van de Water JVD, Miller T, Vogel R, et al.: Impedance cardiography: the next vital sign technology? Chest 2003, 123:2028–2033.CrossRefGoogle Scholar
  10. 10.
    Sageman WS, Riffenburgh RH, Spiess BD: Equivalence of bioimpedance and thermodilution in measuring cardiac index after cardiac surgery. J Cardiothorac Vasc Anesth 2002, 16:8–14.PubMedCrossRefGoogle Scholar
  11. 11.
    Engoren M, Barbee D: Comparison of cardiac output determined by bioimpedance, thermodilution, and the Fick method. Am J Crit Care 2005, 14:40–45.PubMedGoogle Scholar
  12. 12.
    Shoemaker WC, Belzberg H, Wo CC, et al.: Multicenter study of noninvasive monitoring systems as alternatives to invasive monitoring of acutely ill emergency patients. Chest 1998, 114:1643–1652.PubMedGoogle Scholar
  13. 13.
    Ziegler D, Grotti L, Krucke G: Comparison of the use of the pulmonary artery catheter versus thoracic electrical bioimpedance in a medical intensive care unit. Crit Care Med 1999, 27(Suppl S):223.Google Scholar
  14. 14.
    Albert NM, Hail MD, Li J, Young JB: Equivalence of the bioimpedance and thermodilution methods in measuring cardiac output in hospitalized patients with advanced, decompensated chronic heart failure. Am J Crit Care 2004, 13:469–479.PubMedGoogle Scholar
  15. 15.
    Drazner MH, Thompson B, Rosenberg PB, et al.: Comparison of impedance cardiography with invasive hemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy. Am J Cardiol 2002, 89:993–995. Comparison of impedance cardiography with invasive hemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy. The authors demonstrate only fair correlation between thermodilution CO and ICG-measured CO (r = 0.64), and poor sensitivity and specificity for detecting a cardiac index of = 2.2 L/min/m2. The authors also note poor correlation between TFC and wedge pressure.PubMedCrossRefGoogle Scholar
  16. 16.
    Funk M, Nystrom KV, Hutchinson C, et al.: Bioimpedance monitoring in patients with chronic heart failure. J Cardiac Fail 2003, 9(5 Suppl): S6.CrossRefGoogle Scholar
  17. 17.
    Yancy CW, Rogers J, Pauly DF, et al.: Diagnostic implications of impedance cardiography in the setting of severe acute decompensated heart failure: results of the bioimpedance cardiography (BIG) substudy in the ESCAPE trial. Circulation 2005, 112:II-639–II-640. The largest and highest quality study correlating ICG measurements to PAC measurements. Currently in abstract form, the final manuscript detailing poor correlation with PAC measurements should be interesting.Google Scholar
  18. 18.
    Jewkes C, Sear JW, Verhoeff F, et al.: Non-invasive measurement of cardiac output by thoracic electrical bioimpedance: a study of reproducibility and comparison with thermodilution. Br J Anaesth 1991, 67:788–794.PubMedCrossRefGoogle Scholar
  19. 19.
    Woltjer HH, Bogaard HJ, van der Spoel HI, de Vries PM: The influence of weight on stroke volume determination by means of impedance cardiography in cardiac surgery patients. Intensive Care Med 1996, 22:766–771.PubMedGoogle Scholar
  20. 20.
    Campos PC, D’Cruz IA, Johnson LS, et al.: Functional valvular incompetence in decompensated heart failure: noninvasive monitoring and response to medical management. Am J Med Sci 2005, 329:217–221.PubMedCrossRefGoogle Scholar
  21. 21.
    Parrott CW, Burnham KM, Quale C, Lewis DL: Comparison of changes in ejection fraction to changes in impedance cardiography cardiac index and systolic time ratio. Congest Heart Fail 2004, 10(2 Suppl 2):11–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Gimbel JR: Method and demonstration of direct confirmation of response to cardiac resynchronization therapy via preimplant temporary biventricular pacing and impedance cardiography. Am J Cardiol 2005, 96:874–876.PubMedCrossRefGoogle Scholar
  23. 23.
    Johnson W, Voegtlin L, Bailin, SJ, Hoyt RH: Impedance cardiography for acute pacing AV optimization. J Card Fail 2001, 7(Suppl 2):52.Google Scholar
  24. 24.
    Tse HF, Yu C, Park E, Lau CP: Impedance cardiography for atrioventricular interval optimization during permanent left ventricular pacing. Pacing Clin Electrophysiol 2003, 26(1 Part 2):189–191.PubMedCrossRefGoogle Scholar
  25. 25.
    Petersen JR, Jensen BV, Drabaek H, et al.: Electrical impedance measured changes in thoracic fluid content during thoracentesis. Clin Physiol 1994, 15:459–466.Google Scholar
  26. 26.
    Treister N, Wagner K, Jansen PR: Reproducibility of impedance cardiography parameters in outpatients with clinically stable coronary artery disease. Am J Hypertens 2005, 18(2 Part 2):44S-50S.PubMedCrossRefGoogle Scholar
  27. 27.
    Verhoeve PE, Cadwell CA: Reproducibility of noninvasive bioimpedance measurements of cardiac function. J Card Fail 1998, 4(Suppl 1):53.CrossRefGoogle Scholar
  28. 28.
    Greenberg BH, Hermann DD, Pranulis MF, et al.: Reproducibility of impedance cardiography hemodynamic measures in clinically stable heart failure patients. Congest Heart Fail 2000, 6:74–80.PubMedGoogle Scholar
  29. 29.
    Han J, Lindsell C, Tsurov A, Storrow AB: Clinical utility of impedance cardiography in diagnosing congestive heart failure. Acad Emerg Med 2002, 9:439–440.CrossRefGoogle Scholar
  30. 30.
    Marrocco A, Eskin B, Nashed AH, et al.: Noninvasive bioimpedance monitoring differentiates cardiogenic from pulmonary causes of acute dyspnea in the emergency department. Acad Emerg Med 1998, 5:476–477.Google Scholar
  31. 31.
    Springfield CL, Sebat F, Johnson D, et al.: Utility of impedance cardiography to determine cardiac vs. noncardiac cause of dyspnea in the emergency department. Congest Heart Fail 2004, 10(2 Suppl 2):14–16.PubMedCrossRefGoogle Scholar
  32. 32.
    Barcarse E, Kazanegra R, Chen A, et al.: Combination of B-type natriuretic peptide levels and non-invasive hemodynamic parameters in diagnosing congestive heart failure in the emergency department. Congest Heart Fail 2004, 10:171–176.PubMedCrossRefGoogle Scholar
  33. 33.
    Ramirez MFL, Yamamoto ME, Caguioa EVS: Impedance cardiography in heart failure patients in the intensive care unit: its value in the detection of left ventricular systolic dysfunction and correlation with the echocardiogram. J Am Coll Cardiol 2004, 43(5 Suppl A):207A.CrossRefGoogle Scholar
  34. 34.
    Thompson B, Drazner MH, Dries DL, Yancy CW: Is impedance cardiography-derived systolic time ratio a useful method to determine left ventricular systolic dysfunction in heart failure. J Card Fail 2004, 10(Suppl 4):S38.CrossRefGoogle Scholar
  35. 35.
    Milzman DP, Hogan C, Zlindenny A, et al.: The utility of thoracic impedance to evaluate chest radiograph changes from acute heart failure patients in the emergency department. J Card Fail 1998, 4(Suppl 1):37.CrossRefGoogle Scholar
  36. 36.
    Peacock WF, Albert NM, Kies P, et al.: Bioimpedance monitoring: better than chest x-ray for predicting abnormal pulmonary fluid? Congest Heart Fail 1999, 6:86–89.Google Scholar
  37. 37.
    Peacock W, Summers R, Emerman C: Emergent dyspnea impedance cardiography-aided assessment changes therapy: the ED-IMPACT trial. Ann Emerg Med 2003, 42:S82.Google Scholar
  38. 38.
    Binanay C, Califf RM, Hasselblad V, et al.: Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA 2005, 294:1625–1633. A well-controlled study that shows having hemodynamic information does not necessarily lead to better outcomes.PubMedCrossRefGoogle Scholar
  39. 39.
    Hall SA, Cigarroa CG, Marcoux L, et al.: Time course of improvement in left ventricular function, mass and geometry in patients with congestive heart failure treated with beta-adrenergic blockade. J Am Coll Cardiol 1995, 25:1154–1161.PubMedCrossRefGoogle Scholar
  40. 40.
    Cuffe MS, Califf RM, Adams KF Jr, et al.: Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA 2002, 287:1541–1547.PubMedCrossRefGoogle Scholar
  41. 41.
    Lasater M, Von Rueden KT: Outpatient cardiovascular management utilizing impedance cardiography. AACN Clin Issues 2003, 14:240–250.PubMedCrossRefGoogle Scholar
  42. 42.
    Zewail A, Broom C, Eastwood C, et al.: Use of systolic time ratio and B-type natriuretic peptide to predict mortality in patients with heart failure. J Card Fail 2003, 9(Suppl):S105.CrossRefGoogle Scholar
  43. 43.
    Packer M, Abraham WT, Mehra MR, et al.: Utility of impedance cardiography for the identification of shortterm risk of clinical decompensation in stable patients with chronic heart failure. J Am Coll Cardiol 2006, in press.Google Scholar
  44. 44.
    Weinhold C, Reichenspurner H, Fulle P, et al.: Registration of thoracic electrical bioimpedance for early diagnosis of rejection after heart transplantation. J Heart Lung Transplant 1993, 12:832–836.PubMedGoogle Scholar
  45. 45.
    Chevalier S, Basta M, Leitch JW: The importance of the left atrioventricular interval during atrioventricular sequential pacing. Pacing Clin Electrophysiol 1997, 20(12 Part 1):2958–2966.PubMedCrossRefGoogle Scholar
  46. 46.
    Leonelli FM, Wang K, Youssef M, et al.: Systolic and diastolic effects of variable atrioventricular delay in patients with complete heart block and normal ventricular function. Am J Cardiol 1997, 80:294–298.PubMedCrossRefGoogle Scholar
  47. 47.
    Gold MR, Feliciano Z, Gottlieb SS, Fisher ML: Dualchamber pacing with a short atrioventricular delay in congestive heart failure: a randomized study. J Am Coll Cardiol 1995, 26:967–973.PubMedCrossRefGoogle Scholar
  48. 48.
    Hayes DL, Hayes SN, Hyberger LK: Atrioventricular interval optimization technique: impedance measurements vs. echo/Doppler. Pacing Clin Electrophysiol 1998, 21:969.Google Scholar
  49. 49.
    Hayes DL, Hayes SN, Hyberger LK, et al.: Atrioventricular interval optimization after biventricular pacing: echo/Doppler vs. impedance plethysmography. Pacing Clin Electrophysiol 2000, 23:59.Google Scholar
  50. 50.
    Braun MU, Schnabel A, Rauwolf T, et al.: Impedance cardiography as a noninvasive technique for atrioventricular interval optimization in cardiac resynchronization therapy. J Interv Card Electrophysiol 2005, 13:223–229.PubMedCrossRefGoogle Scholar
  51. 51.
    Abdelhammed AI, Smith RD, Levy P, et al.: Noninvasive hemodynamic profiles in hypertensive subjects. Am J Hypertens 2005, 18(2 Part 2):51S-59S.PubMedCrossRefGoogle Scholar
  52. 52.
    Taler SJ, Textor SC, Augustine JE: Resistant hypertension: comparing hemodynamic management to specialist care. Hypertension 2002, 39:982–988.PubMedCrossRefGoogle Scholar
  53. 53.
    Smith RD, Levy P, Ferrario CM, for the Consideration of Noninvasive Hemodynamic Monitoring to Target Reduction of Blood Pressure Levels Study Group: Value of noninvasive hemodynamics to achieve blood pressure control in hypertensive subjects. Hypertension 2006, 47:769–775. Controlled trial of use of ICG to adjust hypertensive medications shows improved blood pressure control. However, it does not answer the question as to whether the benefit is because of better medications used or because of personalized drug selection.CrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.Division of CardiologyUniversity of Maryland School of MedicineBaltimoreUSA

Personalised recommendations