The role of lung impedance monitoring in the

outpatient clinic for predicting and preventing of

hospitalizations of patients with chronic heart
failure
Michael Shochat MD, PhD1, Mark Kazatsker MD1, Vladimir
Gurovich MD¹, Elena Noiman MD¹, Yaniv Levy MD1 , Aya Asif MD1 ,
David Blondhaim MD¹, Avraham Shotan, MD1 , Simcha Meisel MD,
MSc, FACC1

1Heart Institute, Hillel Yaffe Medical Center, Rappaport Faculty of

Medicine, Technion, Haifa, Israel.
Conflict of interest

Dr Shochat is a member of standing advisory of

committee the company developed impedance devices
Background

The clinical course of severe LV dysfunction is typically

characterized by sporadic episodes of decompensation
Thank you very much
and a gradual downhill course. When recovery occurs it
is usually to a slightly lower functional capacity status.

A method to predict and prevent these episodes of

decompensation is needed.
The clinical course of severe LV dysfunction with
sporadic episodes of decompensation
Background

The implantable intra-thoracic impedance device has

shown that lung fluid accumulation in patients with
decompensated chronic heart failure (CHF) begins
several days before admission, but predicts
hospitalizations with only 50-76% accuracy.

Not widely available

 Lung Tissue Resistance 10
Blood resistance 1

Sensitivity of Optivol : 48-76%

This methodology of measuring
chest fluid content is based on the
longitudinal direction of current
propagation.

Most of the electromagnetic energy

passes through the aorta and less
via the high resistance lung tissue.

This is the physiological basis for

the lower sensitivity of this method.

Relation of the Lung Resistance to Blood Resistance 10 : 1

 Transverse direction of
electromagnetic field
through the chest

The lung impedance monitor we used is 15-fold more sensitive

since the methodology is based on transverse direction of current
propagation
Aim

We have evaluated the ability of this new non-

invasive method of lung impedance monitoring to
predict decompensation in CHF patients and to
trigger early therapy in order to prevent
hospitalizations.
Methods

Lung impedance (LI) was measured in outpatient HF

subjects by the device based on transverse
distribution of electromagnetic energy through the
chest.

Changes in the clinical status of patients, LI and NT-

proBNP levels were concurrently recorded at each
outpatient heart failure clinic visit (20±18 days).
Results
150 CHF patients (72±10 years) at NYHA II/III/IV (60/60/30)
were followed for 31±14 months in an outpatient clinic.
Patients were treated with diuretics, beta blockers and
ACEI/ARB/aldosterone. An LI decrease>15% from normal
baseline was used to initiate early preventive therapy since
it has been shown previously that clinical decompensation
occurred at this level of LI decrease. 75 of 150 patients
were treated by clinical evaluation (Group 1) and 75
patients according to LI (Group 2).
 Group 1 (N=75) Group 2 (N=75) P1,2
Mean age 71.9±9.9 years 72.1±10 years NS

NYHA Class (II/III/IV) 31/30/14 29/30/16 NS

Mean Follow up 30.6±13.9 months 31.4±14 months NS

LVEF in % 23±7 23±6 NS

NT-pro BNP (pg/ml) 5820±2434 5868±2532 NS

Β-blockers treatment 91% 90% NS

ACEI and AT1 inhibitors 84% 82% NS

Aldosterone inhibitors 51% 47% NS

Diuretic use 96% 95% NS

Initial Lung Impedance (in Ohms) 60.8±19.2 59.4±19 NS

LVEF and NT-proBNP in groups 1 and 2 were 23±7%,
5820±2434 pg/ml, and 23±6% and 5868±2532 pg/ml,
respectively (p=NS).

140 episodes of LI decrease>15% occurred in group 1

with treatment administered according to clinical
signs only. These episodes of LI decrease included
124 hospitalizations and 35 deaths. Positive predictive
value for hospitalization at LI decrease>15% was 89%.
In group 2, 149 episodes of LI decrease>15% were
recorded. Treatment was immediately intensified.

LI increased in 124 events as the result of treatment

intensification and only 25 hospitalizations were
required (p<0.01). Fourteen patients died (p<0.01).

LI decrease at admission in group 2 (28±5.3%) was

similar to that in group 1 (27±5.6%). Time elapsed
between LI decrease > 15% and hospitalization in
both groups was 16±6 days.
 Treatment of outpatient patients according to clinical evaluation only
Rate of hospitalizations for AHF (Group 1) or according Lung Impedance values (Group 2).

Group 1 (N=75) Group 2 (N=75)

149
140

124 125

P<0.01

25
16

2
3
1
3
1
2

1 – # episodes of Lung Impedance (LI) decrease > 15%

2 – # episodes of hospitalizations throughout 20 days after LI decrease >15%
3 – # episodes without hospitalizations throughout 20 days after LI decrease >15%
 Out-of-hospital mortality at 2.5 years of chronic heart failure patients
Mortality throughout 2.5 years follow up treated according to the 2 different strategies

Group 1 (N=75) Group 2 (N=75)

75 75

35 P<0.01

10

Group 1 patients treated by clinical evaluation only

Group 2 patients treated according to Lung Impedance values
 Mortality rate in groups during follow up period
Mortality rate (Number died patients)

35
Group 1: Treated in outpatient clinic
p=0.001
by common practice )N=75) 30
26 p=0.002
p=0.007
23
21 p=0.016
p=0.021 Group 2: Treated in
16 outpatient clinic according
Lung Impedance (N=75)
p=0.023
10 13 14
p=0.09 11 12
10
6
4
0
6m 1y 1.5 y 2y 2.5 y 3y 3.5 y
Follow up period
CONCLUSIONS
(1) The application of a 15% LI decrease from
baseline as a criterion to initiate therapy resulted in
89% decreased rate of hospitalizations for acutely
decompensated HF.

(2) Pre-emptive LI-guided treatment was associated

with a 2.5-fold reduction of all-cause death during
long-term follow-up.
Thank you for your attention