Usefulness of Lung Impedance-Guided Pre-Emptive Therapy to Prevent Pulmonary Edema During ST-Elevation Myocardial Infarction and to Improve Long-Term Outcomes

Shochat, Michael; Shotan, Avraham; Blondheim, David; Kazatsker, Mark; Dahan, Iris; Asif, Aya; Shochat, Ilia; Rabinovich, Pavel; Rozenman, Yoseph; Meisel, Simcha

doi:10.1016/j.amjcard.2012.03.009

Cited by 16 publications

(18 citation statements)

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“…While the change in the level of blood N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) during hospitalization for HF was found to be a useful predictor of readmissions, using of NT‐proBNP to guide therapy is controversial . Finally, a promising method to monitor and assess lung fluid content is the lung impedance (LI) technique . The recently published randomized IMPEDANCE‐HF trial demonstrated the efficacy of LI‐guided monitoring in the treatment of HF patients and has shown that LI‐guided therapy decreased hospitalizations for HF as well as HF‐associated and all‐cause mortality.…”

Section: Introductionmentioning

confidence: 99%

Prediction of readmissions and mortality in patients with heart failure: lessons from the IMPEDANCE‐HF extended trial

et al. 2018

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AimsReadmissions for heart failure (HF) are a major burden. We aimed to assess whether the extent of improvement in pulmonary fluid content (ΔPC) during HF hospitalization evaluated by lung impedance (LI), or indirectly by other clinical and laboratory parameters, predicts readmissions.Methods and resultsThe present study is based on pre‐defined secondary analysis of the IMPEDANCE‐HF extended trial comprising 266 HF patients at New York Heart Association Class II–IV and left ventricular ejection fraction ≤ 35% randomized to LI‐guided or conventional therapy during long‐term follow‐up. Lung impedance‐guided patients were followed for 58 ± 36 months and the control patients for 46 ± 34 months (P < 0.01) accounting for 253 and 478 HF hospitalizations, respectively (P < 0.01). Lung impedance, N‐terminal pro‐brain natriuretic peptide, weight, radiological score, New York Heart Association class, lung rales, leg oedema, or jugular venous pressure were measured at admission and discharge on each hospitalization in both groups with the difference defined as ΔPC. Average LI‐assessed ΔPC was 12.1% vs. 9.2%, and time to HF readmission was 659 vs. 306 days in the LI‐guided and control groups, respectively (P < 0.01). Lung impedance‐based ΔPC predicted 30 and 90 day HF readmission better than ΔPC assessed by the other variables (P < 0.01). The readmission rate for HF was lower if ΔPC > median compared with ΔPC ≤ median for all parameters evaluated in both study groups with the most pronounced difference predicted by LI (P < 0.01). Net reclassification improvement analysis showed that adding LI to the traditional clinical and laboratory parameters improved the predictive power significantly.ConclusionsThe extent of ΔPC improvement, primarily the LI based, during HF‐hospitalization, and study group allocation strongly predicted readmission and event‐free survival time.

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Section: Introductionmentioning

confidence: 99%

Prediction of readmissions and mortality in patients with heart failure: lessons from the IMPEDANCE‐HF extended trial

et al. 2018

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“…The current study deals with the diagnosis of pleural effusion in elderly population [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Its results demonstrate that continuous ITI monitoring of patients with pulmonary effusion is a useful and accurate method for diagnosis and prediction of respiratory distress and for proper preventive therapeutic management.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies we have shown the suitability of the RS-207 monitor (R. S. Medical Monitoring, Jerusalem, Israel) for measuring ITI and early diagnosis of pulmonary edema and pleural effusion from different etiologies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. So far, not any studies have dealt with early diagnosis of pleural effusion in pure HF cohort who, most frequently, suffer from pleural effusion, by use of this noninvasive and inexpensive method.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the currently available methods for the early detection and monitoring of pulmonary edema were not studied for pleural effusion and are not sufficiently reliable and may themselves lead to complications [1][2][3][4][5][6][7][8][9][10]. The changes in the extravascular fluid content in the lungs in humans and animals can be easily monitored by a noninvasive procedure based on impedance plethysmography of right lung [8][9][10][11][12][13][14][15]. Total transthoracic impedance (TTI) consists of ITI and skin contact impedance.…”

Section: Introductionmentioning

confidence: 99%

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The Usefulness of Monitoring Pleural Effusion Treatment by the Internal Thoracic Impedance Method

2015

JCCR

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The Edema Guard Monitor (EGM) model Jerusalem, Israel [12], in contrast to the other currently available impedance monitors, measures the ITI of the right lung, which roughly equals lung impedance, by automatically calculating skin electrode impedance and subtracting it from Research Article AbstractBackground: Internal thoracic impedance (ITI) is a sensitive and reliable method used to detect pulmonary fluids accumulation as, pulmonary edema or pleural effusion. The current study deals with this noninvasive method in heart failure patients, its usefulness in detecting pleural effusion before the appearance of clinical symptoms and for demonstrating increased ITI during its resolution. Methods:A prospective controlled study performed in a single department of internal medicine belonging to a university-affiliated hospital between the years -2012-2013. Sixty two patients (ages ranging from 41 to 94) were recruited for the study, of whom 31 with bilateral or right pleural effusion of any etiology (study group) and 31without pleural effusion (control group) who were admitted because of heart failure (HF). ITI was continuously measured by the RS-207 monitor. The predictive value of ITI monitoring was determined by 8 measurements taken every 8 hours. Pleural effusion was diagnosed and followed by main clinical signs and also chest X ray as a gold standard modality before and at the end of the monitoring. Results:During the 56 hours of treatment, the median ITI of the study group increased by 21.5% -from 33.1±4.2 to 42.1±3.9 ohm (P < 0.001) as compared to the non significant changes in the control group 59.4±5.2 (P = NS). Prominent changes were observed in the respiratory rate (RR) of the study group: there was a decrease from 31.2±4.2to 19.7±2.3 (36.5%) -as compared to no changes for the controls, and a mean increase of elevation from 83.5±5.3% (9.1%) in O2 saturation to 92.4±1.5% as compared to94.3±2.1 (p-NS) for the controls. Conclusion:ITI methodology is useful for the diagnosis and monitoring of treatment of HF patients with pleural effusion as it enables diagnosis in the preclinical stage. ITI may provide early and better treatment, and can prevent complications such as respiratory distress, intubation and make hospitalization unnecessary. There were no significant ITI changes in HF patients as compared to the mixed general population.

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“…Advanced stages of APE cause considerable distress to patients and are difficult to treat because of a vicious cycle in which deteriorating arterial oxygen saturation due to pulmonary congestion leads to failing myocardial function which, in turn, leads to further decrease in oxygen saturation [1]. Preventive treatment (PT) of APE might interrupt its development by aborting the vicious cycle that progressively leads to HF [2].…”

Section: Introductionmentioning

confidence: 99%

Preventive treatment of alveolar pulmonary edema of cardiogenic origin

Charach¹,

Shochat²,

Rabinovich³

et al. 2013

Journal of Geriatric Cardiology

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ObjectiveTo evaluate the efficacy of preventive treatment (PT) on alveolar pulmonary edema (APE) of cardiogenic origin using a monitor based on principles of internal thoracic impedance (ITI) measurements.MethodsWe conducted blinded clinical trials on patients with ST-elevation myocardial infarction (STEMI) and monitored whether the condition would progress to APE. ITI was measured non-invasively by the Edema Guard Monitor (EGM, model RS-207) every 30 min. The measurement threshold for the diagnosis of APE was fixed at > 12% decrease in ITI from baseline as described in our methodology. The patients were divided into one group that received standard treatment after the appearance of clinical signs of APE without considering the prediction of APE by EGM devise (Group 1), and another group of asymptomatic patients in whom development of APE was predicted by using only EGM measurements (Group 2). The latter participants' PT consisted of furosemide, intravenous nitroglycerine and supplemental oxygen.ResultsOne-hundred and fifty patients with acute STEMI were enrolled into this study. Group 1 included 100 patients (53% males, age 64.1 ± 12.6 years). Treatment was started after the clinical appearance of overt signs of APE. Group 2 included 50 patients (54% males, age 65.2 ± 11.9 years) who received PT based on EGM measurements. Group 2 had significantly fewer cases of APE (n = 4, 8%) than Group 1 (n = 100, 100%) (P > 0.001). While APE was lethal in six (6%) Group 1 patients, PT resulted in prompt resolution of APE in all four (8%) Group 2 patients.ConclusionITI is a useful modality for early diagnosis and PT of pulmonary edema of cardiogenic origin.

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Usefulness of Lung Impedance-Guided Pre-Emptive Therapy to Prevent Pulmonary Edema During ST-Elevation Myocardial Infarction and to Improve Long-Term Outcomes

Cited by 16 publications

References 23 publications

Prediction of readmissions and mortality in patients with heart failure: lessons from the IMPEDANCE‐HF extended trial

Prediction of readmissions and mortality in patients with heart failure: lessons from the IMPEDANCE‐HF extended trial

The Usefulness of Monitoring Pleural Effusion Treatment by the Internal Thoracic Impedance Method

Preventive treatment of alveolar pulmonary edema of cardiogenic origin

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