Skip to main content
Erschienen in: Lung 5/2011

01.10.2011

Value of Impedance Cardiography in Patients Studied for Pulmonary Hypertension

verfasst von: Adriano R. Tonelli, Hassan Alnuaimat, Ning Li, Robin Carrie, Kamal K. Mubarak

Erschienen in: Lung | Ausgabe 5/2011

Einloggen, um Zugang zu erhalten

Abstract

The aim of this study was to evaluate the accuracy and precision of impedance cardiography as a method for noninvasive hemodynamic evaluation of patients with pulmonary hypertension (PH). We performed a prospective and blinded study of patients who underwent right heart catheterization (RHC) for evaluation of known or presumed PH at the University of Florida from August 2009 to March 2010. The cohort consisted of a total of 39 patients (age = 57 ± 14 years, 87% women) with presumed (23%) or confirmed PH (77%) of different etiologies. Patients underwent RHC and impedance cardiography using the PhysioFlow PF-05. The PhysioFlow PF-05 measures cardiac output (CO) and LV end-diastolic volume (LVEDV), among other parameters. The median pulmonary artery pressure was 36 (IQR 26-56) mmHg. The CO (mean ± SD) by thermodilution (CO-T) and by impedance cardiography (CO-IC) was 5.9 ± 2.2 and 5.6 ± 1.5 L/min, respectively. Bland-Altman analysis of CO-T versus CO-IC revealed a mean of 0.3 L/min (95% LoA: −2.2 to +2.8). In patients with PH, the correlation of CO-T and CO-IC had a mean of 0.4 L/min (95% LoA: 2.9 and −2.2). Pulmonary artery occlusion pressure (PAOP) correlated with LVEDV (R 2 = 0.2, p = 0.005). By ROC analysis, EDV ≥ 200 ml had a sensitivity of 53% and a specificity of 86% for PAOP > 15 mmHg (AUC = 0.78). In patients with PH, impedance cardiography had good accuracy and fair precision for CO determination when compared with thermodilution. Impedance cardiography may provide information about the preload status and has the potential to become a cost-effective and noninvasive method for the follow-up of patients with PH.
Literatur
1.
Zurück zum Zitat Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A et al (2009) Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol 54(1 Suppl):S55–S66PubMedCrossRef Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A et al (2009) Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol 54(1 Suppl):S55–S66PubMedCrossRef
2.
Zurück zum Zitat Tonelli AR, Alnuaimat H, Mubarak K (2010) Pulmonary vasodilator testing and use of calcium channel blockers in pulmonary arterial hypertension. Respir Med 104(4):481–496PubMedCrossRef Tonelli AR, Alnuaimat H, Mubarak K (2010) Pulmonary vasodilator testing and use of calcium channel blockers in pulmonary arterial hypertension. Respir Med 104(4):481–496PubMedCrossRef
3.
Zurück zum Zitat Swiston JR, Johnson SR, Granton JT (2010) Factors that prognosticate mortality in idiopathic pulmonary arterial hypertension: a systematic review of the literature. Respir Med 104(11):1588–1607PubMedCrossRef Swiston JR, Johnson SR, Granton JT (2010) Factors that prognosticate mortality in idiopathic pulmonary arterial hypertension: a systematic review of the literature. Respir Med 104(11):1588–1607PubMedCrossRef
4.
Zurück zum Zitat McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR et al (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation 119(16):2250–2294PubMedCrossRef McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR et al (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation 119(16):2250–2294PubMedCrossRef
5.
Zurück zum Zitat Ventetuolo CE, Benza RL, Peacock AJ, Zamanian RT, Badesch DB, Kawut SM (2008) Surrogate and combined end points in pulmonary arterial hypertension. Proc Am Thorac Soc 5(5):617–622PubMedCrossRef Ventetuolo CE, Benza RL, Peacock AJ, Zamanian RT, Badesch DB, Kawut SM (2008) Surrogate and combined end points in pulmonary arterial hypertension. Proc Am Thorac Soc 5(5):617–622PubMedCrossRef
6.
Zurück zum Zitat Roberts K, Preston I, Hill NS (2006) Pulmonary hypertension trials: current end points are flawed, but what are the alternatives? Chest 130(4):934–936PubMedCrossRef Roberts K, Preston I, Hill NS (2006) Pulmonary hypertension trials: current end points are flawed, but what are the alternatives? Chest 130(4):934–936PubMedCrossRef
7.
Zurück zum Zitat Lasater M, Von Rueden KT (2003) Outpatient cardiovascular management utilizing impedance cardiography. AACN Clin Issues 14(2):240–250PubMedCrossRef Lasater M, Von Rueden KT (2003) Outpatient cardiovascular management utilizing impedance cardiography. AACN Clin Issues 14(2):240–250PubMedCrossRef
8.
Zurück zum Zitat Parry MJ, McFetridge-Durdle J (2006) Ambulatory impedance cardiography: a systematic review. Nurs Res 55(4):283–291PubMedCrossRef Parry MJ, McFetridge-Durdle J (2006) Ambulatory impedance cardiography: a systematic review. Nurs Res 55(4):283–291PubMedCrossRef
9.
Zurück zum Zitat Sodolski T, Kutarski A (2007) Impedance cardiography: a valuable method of evaluating haemodynamic parameters. Cardiol J 14(2):115–126PubMed Sodolski T, Kutarski A (2007) Impedance cardiography: a valuable method of evaluating haemodynamic parameters. Cardiol J 14(2):115–126PubMed
10.
Zurück zum Zitat Bour J, Kellett J (2008) Impedance cardiography: a rapid and cost-effective screening tool for cardiac disease. Eur J Intern Med 19(6):399–405PubMedCrossRef Bour J, Kellett J (2008) Impedance cardiography: a rapid and cost-effective screening tool for cardiac disease. Eur J Intern Med 19(6):399–405PubMedCrossRef
11.
Zurück zum Zitat Richard R, Lonsdorfer-Wolf E, Charloux A, Doutreleau S, Buchheit M, Oswald-Mammosser M et al (2001) Non-invasive cardiac output evaluation during a maximal progressive exercise test, using a new impedance cardiograph device. Eur J Appl Physiol 85(3–4):202–207PubMedCrossRef Richard R, Lonsdorfer-Wolf E, Charloux A, Doutreleau S, Buchheit M, Oswald-Mammosser M et al (2001) Non-invasive cardiac output evaluation during a maximal progressive exercise test, using a new impedance cardiograph device. Eur J Appl Physiol 85(3–4):202–207PubMedCrossRef
12.
Zurück zum Zitat Van De Water JM, Miller TW, Vogel RL, Mount BE, Dalton ML (2003) Impedance cardiography: the next vital sign technology? Chest 123(6):2028–2033CrossRef Van De Water JM, Miller TW, Vogel RL, Mount BE, Dalton ML (2003) Impedance cardiography: the next vital sign technology? Chest 123(6):2028–2033CrossRef
13.
Zurück zum Zitat Tan KH, Lai FO, Hwang NC (2006) Measurement of cardiac output using Physio Flow with different positions of electrode placement. Singapore Med J 47(11):967–970PubMed Tan KH, Lai FO, Hwang NC (2006) Measurement of cardiac output using Physio Flow with different positions of electrode placement. Singapore Med J 47(11):967–970PubMed
14.
Zurück zum Zitat Charloux A, Lonsdorfer-Wolf E, Richard R, Lampert E, Oswald-Mammosser M, Mettauer B et al (2000) A new impedance cardiograph device for the non-invasive evaluation of cardiac output at rest and during exercise: comparison with the “direct” Fick method. Eur J Appl Physiol 82(4):313–320PubMedCrossRef Charloux A, Lonsdorfer-Wolf E, Richard R, Lampert E, Oswald-Mammosser M, Mettauer B et al (2000) A new impedance cardiograph device for the non-invasive evaluation of cardiac output at rest and during exercise: comparison with the “direct” Fick method. Eur J Appl Physiol 82(4):313–320PubMedCrossRef
15.
Zurück zum Zitat Tonelli AR, Mubarak KK, Li N, Carrie R, Alnuaimat H (2011) Effect of balloon inflation volume on pulmonary artery occlusion pressure in patients with and without pulmonary hypertension. Chest 139(1):115–121PubMedCrossRef Tonelli AR, Mubarak KK, Li N, Carrie R, Alnuaimat H (2011) Effect of balloon inflation volume on pulmonary artery occlusion pressure in patients with and without pulmonary hypertension. Chest 139(1):115–121PubMedCrossRef
16.
Zurück zum Zitat Sommers MS, Woods SL, Courtade MA (1993) Issues in methods and measurement of thermodilution cardiac output. Nurs Res 42(4):228–233PubMedCrossRef Sommers MS, Woods SL, Courtade MA (1993) Issues in methods and measurement of thermodilution cardiac output. Nurs Res 42(4):228–233PubMedCrossRef
17.
Zurück zum Zitat Capan LM, Bernstein DP, Patel KP, Sanger J, Turndorf H (1987) Measurement of ejection fraction by a bioimpedance method. Crit Care Med 15:402CrossRef Capan LM, Bernstein DP, Patel KP, Sanger J, Turndorf H (1987) Measurement of ejection fraction by a bioimpedance method. Crit Care Med 15:402CrossRef
18.
Zurück zum Zitat Hsu AR, Barnholt KE, Grundmann NK, Lin JH, McCallum SW, Friedlander AL (2006) Sildenafil improves cardiac output and exercise performance during acute hypoxia, but not normoxia. J Appl Physiol 100(6):2031–2040PubMedCrossRef Hsu AR, Barnholt KE, Grundmann NK, Lin JH, McCallum SW, Friedlander AL (2006) Sildenafil improves cardiac output and exercise performance during acute hypoxia, but not normoxia. J Appl Physiol 100(6):2031–2040PubMedCrossRef
19.
Zurück zum Zitat Sageman WS, Riffenburgh RH, Spiess BD (2002) Equivalence of bioimpedance and thermodilution in measuring cardiac index after cardiac surgery. J Cardiothorac Vasc Anesth 16(1):8–14PubMedCrossRef Sageman WS, Riffenburgh RH, Spiess BD (2002) Equivalence of bioimpedance and thermodilution in measuring cardiac index after cardiac surgery. J Cardiothorac Vasc Anesth 16(1):8–14PubMedCrossRef
20.
Zurück zum Zitat Albert NM, Hail MD, Li J, Young JB (2004) Equivalence of the bioimpedance and thermodilution methods in measuring cardiac output in hospitalized patients with advanced, decompensated chronic heart failure. Am J Crit Care 13(6):469–479PubMed Albert NM, Hail MD, Li J, Young JB (2004) Equivalence of the bioimpedance and thermodilution methods in measuring cardiac output in hospitalized patients with advanced, decompensated chronic heart failure. Am J Crit Care 13(6):469–479PubMed
21.
Zurück zum Zitat Barin E, Haryadi DG, Schookin SI, Westenskow DR, Zubenko VG, Beliaev KR et al (2000) Evaluation of a thoracic bioimpedance cardiac output monitor during cardiac catheterization. Crit Care Med 28(3):698–702PubMedCrossRef Barin E, Haryadi DG, Schookin SI, Westenskow DR, Zubenko VG, Beliaev KR et al (2000) Evaluation of a thoracic bioimpedance cardiac output monitor during cardiac catheterization. Crit Care Med 28(3):698–702PubMedCrossRef
22.
Zurück zum Zitat Fuller HD (1992) The validity of cardiac output measurement by thoracic impedance: a meta-analysis. Clin Invest Med 15(2):103–112PubMed Fuller HD (1992) The validity of cardiac output measurement by thoracic impedance: a meta-analysis. Clin Invest Med 15(2):103–112PubMed
23.
Zurück zum Zitat Haynes G, Moreau X, Rousseau J, Thiranos J, Dubè L (2006) Cardiac output with a new bioimpedance monitor: comparison with thermodilution methods. Anesthesiology 105:A470 Haynes G, Moreau X, Rousseau J, Thiranos J, Dubè L (2006) Cardiac output with a new bioimpedance monitor: comparison with thermodilution methods. Anesthesiology 105:A470
24.
Zurück zum Zitat Yung GL, Fedullo PF, Kinninger K, Johnson W, Channick RN (2004) Comparison of impedance cardiography to direct Fick and thermodilution cardiac output determination in pulmonary arterial hypertension. Congest Heart Fail 10(2 Suppl 2):7–10PubMedCrossRef Yung GL, Fedullo PF, Kinninger K, Johnson W, Channick RN (2004) Comparison of impedance cardiography to direct Fick and thermodilution cardiac output determination in pulmonary arterial hypertension. Congest Heart Fail 10(2 Suppl 2):7–10PubMedCrossRef
25.
Zurück zum Zitat LaMantia KR, O’Connor T, Barash PG (1990) Comparing methods of measurement: an alternative approach. Anesthesiology 72(5):781–783PubMedCrossRef LaMantia KR, O’Connor T, Barash PG (1990) Comparing methods of measurement: an alternative approach. Anesthesiology 72(5):781–783PubMedCrossRef
26.
Zurück zum Zitat Critchley LA, Critchley JA (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15(2):85–91PubMedCrossRef Critchley LA, Critchley JA (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15(2):85–91PubMedCrossRef
27.
Zurück zum Zitat Summers RL, Shoemaker WC, Peacock WF, Ander DS, Coleman TG (2003) Bench to bedside: electrophysiologic and clinical principles of noninvasive hemodynamic monitoring using impedance cardiography. Acad Emerg Med 10(6):669–680PubMedCrossRef Summers RL, Shoemaker WC, Peacock WF, Ander DS, Coleman TG (2003) Bench to bedside: electrophysiologic and clinical principles of noninvasive hemodynamic monitoring using impedance cardiography. Acad Emerg Med 10(6):669–680PubMedCrossRef
28.
Zurück zum Zitat Shoemaker WC, Belzberg H, Wo CC, Milzman DP, Pasquale MD, Baga L et al (1998) Multicenter study of noninvasive monitoring systems as alternatives to invasive monitoring of acutely ill emergency patients. Chest 114(6):1643–1652PubMedCrossRef Shoemaker WC, Belzberg H, Wo CC, Milzman DP, Pasquale MD, Baga L et al (1998) Multicenter study of noninvasive monitoring systems as alternatives to invasive monitoring of acutely ill emergency patients. Chest 114(6):1643–1652PubMedCrossRef
29.
Zurück zum Zitat Drazner MH, Thompson B, Rosenberg PB, Kaiser PA, Boehrer JD, Baldwin BJ et al (2002) Comparison of impedance cardiography with invasive hemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy. Am J Cardiol 89(8):993–995PubMedCrossRef Drazner MH, Thompson B, Rosenberg PB, Kaiser PA, Boehrer JD, Baldwin BJ et al (2002) Comparison of impedance cardiography with invasive hemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy. Am J Cardiol 89(8):993–995PubMedCrossRef
30.
Zurück zum Zitat Kamath SA, Drazner MH, Tasissa G, Rogers JG, Stevenson LW, Yancy CW (2009) 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. Am Heart J 158(2):217–223PubMedCrossRef Kamath SA, Drazner MH, Tasissa G, Rogers JG, Stevenson LW, Yancy CW (2009) 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. Am Heart J 158(2):217–223PubMedCrossRef
31.
Zurück zum Zitat Hansen RM, Viquerat CE, Matthay MA, Wiener-Kronish JP, DeMarco T, Bahtia S et al (1986) Poor correlation between pulmonary arterial wedge pressure and left ventricular end-diastolic volume after coronary artery bypass graft surgery. Anesthesiology 64(6):764–770PubMedCrossRef Hansen RM, Viquerat CE, Matthay MA, Wiener-Kronish JP, DeMarco T, Bahtia S et al (1986) Poor correlation between pulmonary arterial wedge pressure and left ventricular end-diastolic volume after coronary artery bypass graft surgery. Anesthesiology 64(6):764–770PubMedCrossRef
32.
Zurück zum Zitat Sadauskas S, Naudziunas A, Gargasas L, Ruseckas R, Jurkoniene R (2006) Evaluation of systolic pressure in pulmonary artery by using impedance cardiography method. Medicina (Kaunas) 42(6):464–471 Sadauskas S, Naudziunas A, Gargasas L, Ruseckas R, Jurkoniene R (2006) Evaluation of systolic pressure in pulmonary artery by using impedance cardiography method. Medicina (Kaunas) 42(6):464–471
33.
Zurück zum Zitat Woltjer HH, Bogaard HJ, Bronzwaer JG, de Cock CC, de Vries PM (1997) Prediction of pulmonary capillary wedge pressure and assessment of stroke volume by noninvasive impedance cardiography. Am Heart J 134(3):450–455PubMedCrossRef Woltjer HH, Bogaard HJ, Bronzwaer JG, de Cock CC, de Vries PM (1997) Prediction of pulmonary capillary wedge pressure and assessment of stroke volume by noninvasive impedance cardiography. Am Heart J 134(3):450–455PubMedCrossRef
Metadaten
Titel
Value of Impedance Cardiography in Patients Studied for Pulmonary Hypertension
verfasst von
Adriano R. Tonelli
Hassan Alnuaimat
Ning Li
Robin Carrie
Kamal K. Mubarak
Publikationsdatum
01.10.2011
Verlag
Springer-Verlag
Erschienen in
Lung / Ausgabe 5/2011
Print ISSN: 0341-2040
Elektronische ISSN: 1432-1750
DOI
https://doi.org/10.1007/s00408-011-9299-y

Weitere Artikel der Ausgabe 5/2011

Lung 5/2011 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.