Author + information
- Received August 3, 2005
- Revision received December 14, 2005
- Accepted December 16, 2005
- Published online June 6, 2006.
- Milton Packer, MD, FACC⁎,⁎ (, )
- William T. Abraham, MD, FACC†,
- Mandeep R. Mehra, MD, FACC‡,
- Clyde W. Yancy, MD, FACC⁎,
- Christine E. Lawless, MD, FACC§,
- Judith E. Mitchell, MD, FACC∥,
- Frank W. Smart, MD, FACC¶,
- Rachel Bijou, MD, FACC#,
- Christopher M. O’Connor, MD, FACC⁎⁎,
- Barry M. Massie, MD, FACC††,
- Ileana L. Pina, MD, FACC‡‡,
- Barry H. Greenberg, MD, FACC§§,
- James B. Young, MD, FACC∥∥,
- Daniel P. Fishbein, MD, FACC¶¶,
- Paul J. Hauptman, MD, FACC##,
- Robert C. Bourge, MD, FACC⁎⁎⁎,
- John E. Strobeck, MD, PhD, FACC†††,
- Srinvivas Murali, MD, FACC‡‡‡,
- Douglas Schocken, MD, FACC§§§,
- John R. Teerlink, MD, FACC††,
- Wayne C. Levy, MD, FACC¶¶,
- Robin J. Trupp, MSN, RN⁎,
- Marc A. Silver, MD, FACC∥∥∥,
- Prospective Evaluation and Identification of Cardiac Decompensation by ICG Test (PREDICT) Study Investigators and Coordinators
- ↵⁎Reprint requests and correspondence:
Dr. Milton Packer, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Room E5.506P, Dallas, Texas 75390-8822.
Objectives This study sought to assess the potential utility of impedance cardiography (ICG) in predicting clinical deterioration in ambulatory patients with heart failure (HF).
Background Impedance cardiography uses changes in thoracic electrical impedance to estimate hemodynamic variables, but its ability to predict clinical events has not been evaluated.
Methods We prospectively evaluated 212 stable patients with HF and a recent episode of clinical decompensation who underwent serial clinical evaluation and blinded ICG testing every 2 weeks for 26 weeks and were followed up for the occurrence of death or worsening HF requiring hospitalization or emergent care.
Results During the study, 59 patients experienced 104 episodes of decompensated HF (16 deaths, 78 hospitalizations, and 10 emergency visits). Multivariate analysis identified 6 clinical and ICG variables that independently predicted an event within 14 days of assessment. These included three clinical variables (visual analog score, New York Heart Association functional class, and systolic blood pressure) and three ICG parameters (velocity index, thoracic fluid content index, and left ventricular ejection time). The three ICG parameters combined into a composite score was a powerful predictor of an event during the next 14 days (p = 0.0002). Visits with a high-risk composite score had 2.5 times greater likelihood and those with a low-risk score had a 70% lower likelihood of a near-term event compared with visits at intermediate risk.
Conclusions These results suggest that when performed at regular intervals in stable patients with HF with a recent episode of clinical decompensation, ICG can identify patients at increased near-term risk of recurrent decompensation.
Some authors have received consulting fees and honoraria from CardioDynamics, and all authors received research grants from CardioDynamics to support the study. Mihai Gheorgiade, MD, FACC, served as Guest Editor for this paper.
- Received August 3, 2005.
- Revision received December 14, 2005.
- Accepted December 16, 2005.
- American College of Cardiology Foundation