Abstract
Transthoracic and whole-body bioimpedance monitoring has been commercially available for years; however, attention to its use as a diagnostic and event-monitoring modality has not been routinely applied in patients with heart failure (HF). In 2005, intrathoracic bioimpedance monitoring via an implantable cardioverter defibrillator brought new awareness of bioimpedance technology. In addition, new knowledge about congestion in HF, including length of time a patient is congested before seeking emergency care, lack of sensitivity of common signs and symptoms used to monitor congestion and diagnose HF exacerbation, and poor clinical outcomes when hypervolemia is present, heightened the need for more aggressive assessment and management. Bioimpedance device monitoring provides data needed to make treatment decisions that promote euvolemia and optimal cardiac performance. This review summarizes three options for measurement of bioimpedance hemodynamic data, discusses its use in preventing HF hospitalization, and describes issues that need to be overcome before bioimpedance monitoring can be routinely used in HF management.
Similar content being viewed by others
References and Recommended Reading
Cotter G, Moshkovitz Y, Kaluski E et al.: Accurate, noninvasive continuous monitoring of cardiac output by whole-body electrical impedance. Chest 2004, 125:1431–1440.
Sramek BB: Thoracic electrical bioimpedance: basic principles and physiologic relationship. Noninvas Cardiol 1994, 3:83–88.
Critchley LA, Zhang Y, Critchley JA, Chung RC: A comparison of two impedance cardiographs using head-up tilting and trend analysis. J Clin Monit Comput 2002, 17:153–160.
Kööbi T, Kaukinen S, Ahola T, Turjanmaa VM: Non-invasive measurement of cardiac output: whole-body impedance cardiography in simultaneous comparison with thermodilution and direct oxygen Fick methods. Intensive Care Med 1997, 23:1132–1137.
Yu CM, Wang L, Chao E, et al.: Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning predicting hospitalization. Circulation 2005, 112:841–848. This paper represents the first published clinical study of intrathoracic impedance monitoring over time in patients with HF. There was a strong inverse correlation with intrathoracic impedance and pulmonary capillary wedge pressure and among intrathoracic impedance and net fluid loss during hospitalization with few false-positive detections.
Vijayaraghavan K, Crum S, Cherukuri S, Barnett-Avery L: Association of impedance cardiography parameters with changes in functional and quality-of-life measures in patients with chronic heart failure. Congest Heart Fail 2004, 10(Suppl 2):22–27.
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.
Silver M, Cianci P, Brennan S, et al.: Evaluation of impedance cardiography as an alternative to pulmonary artery catheterization in critically ill patients. Congest Heart Fail 2004, 10(Suppl 2):17–21.
Parrott C, Burnham K, Quale C, Lewis D: 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.
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.
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.
Engoren M, Barbee D: Comparison of cardiac output determined by bioimpedance, thermodilution, and the Fick method. Am J Crit Care 2005, 14:40–45.
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(Suppl II):II639-II640.
Fonarow GC, Stevenson LW, Steimle AE, et al.: Persistently high left ventricular filling pressures predict mortality despite angiotensin converting enzyme inhibition in advanced heart failure. Circulation 1994, 90(Suppl I):I-488.
Wyatt J, Smith B, Krasuski R, et al.: Impedance cardiography as a predictor of clinical outcome in heart failure patients. J Am Coll Cardiol 2006, 47(Suppl A):79A.
Schnitzler RN, Paparelli V: A word salad in the treatment of CHF: BVA, ICG, BNP. J Card Fail 2005, 11(6 Suppl):S201.
Wang L, Lahtinen S, Lentz L, et al.: Feasibility of using an implantable system to measure thoracic congestion in an ambulatory chronic heart failure canine model. Pacing Clin Electrophysiol 2005, 28:404–411.
Abraham W, Trupp R, Mehra MR, et al.: A multivariate impedance cardiography composite score can predict the occurrence of major heart failure events: the PREDICT study. Circulation 2004, 10(Suppl II):597.
Castellanos LR, Bhalla V, Isakson S, et al.: B-type natriuretic peptide and impedance cardiography testing at a time of routine echocardiography predict subsequent heart failure events. J Card Fail 2005, 11(6 Suppl):S123.
Thom T, Haase N, Rosamond W, et al.: Heart Disease and Stroke Statistics—2006 Update: a Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006, 113:e85-e151.
Massie BM, Shah NB: Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am Heart J 1997, 133:703–712.
Bonow RO, Smaha LA, Smith SC, Jr., et al.: World Heart Day 2002: the international burden of cardiovascular disease: responding to the emerging global epidemic. Circulation 2002, 106:1602–1605.
Mueller C, Frana B, Rodriquez D, et al.: Emergency diagnosis of congestive heart failure: impact of signs and symptoms. Can J Cardiol 2005, 21:921–924.
Androne AS, Hryniewicz K, Hudaihed A, et al.: Relation of unrecognized hypervolemia in chronic heart failure to clinical status, hemodynamics, and patient outcomes. Am J Cardiol 2004, 93:1254–1259.
Stevenson LW, Perloff JK: The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA 1989, 261:884–888.
Chakko S, Woska D, Martinex H, et al.: Clinical, radiographic and hemodynamic correlations in chronic congestive heart failure: conflicting results may lead to inappropriate care. Am J Med 1991, 90:353–359.
Butman SM, Ewy GA, Standen JR, et al.: Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension. J Am Coll Cardiol 1993, 22:968–974.
Hunt SA, Abraham WT, Chin MH, et al.: ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure); 2005. Available at http://www. acc.org/clinical/guidelines/failure/index.pdf.
Stevenson LW: Are hemodynamic goals viable in tailoring heart failure therapy? Hemodynamic goals are relevant. Circulation 2006, 113:1020–1033. This descriptive article provides an overview of tailoring therapies to congestive symptoms and reinforces why there is a need to measure hemodynamics in patient care. In this article, hemodynamic measurement is synonymous with pulmonary artery catheterization; however, the author recognizes that our tools are primitive and future research is needed.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Albert, N.M. Bioimpedance to prevent heart failure hospitalization. Curr Heart Fail Rep 3, 136–142 (2006). https://doi.org/10.1007/s11897-006-0013-y
Issue Date:
DOI: https://doi.org/10.1007/s11897-006-0013-y