J Clin Monit Comput - Thoracic impedance measures tissue characteristics in the vicinity of the electrodes, not intervening lung water: implications for heart failure monitoring.

Tópicos

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Resumo

The rationale for intrathoracic impedance (Z) detection of worsening heart failure (HF) presupposes that changes in Z reflect changes in pulmonary congestion, but is confounded by poor specificity in clinical trials. We therefore tested the hypothesis that Z is primarily affected by tissue/water content in proximity to electrodes rather than by lung water distribution between electrodes through the use of a new computational model for deriving the near-field impedance contributions from the various electrodes. Six sheep were implanted with a left atrial pressure (LAP) monitor and a cardiac resynchronization therapy device which measured Z from six vectors comprising of five electrodes. The vector-based Z was modelled as the summation of the near-field impedances of the two electrodes forming the vector. During volume expansion an acute increase in LAP resulted in simultaneous reductions in the near-field impedances of the intra-cardiac electrodes, while the subcutaneous electrode showed several hours of lag (all p<0.001). In contrast, during the simulated formation of device-pocket edema (induced by fluid injection) the near-field impedance of the subcutaneous electrode had an instantaneous response, while the intra-cardiac electrodes had a minimal inconsistent response. This study suggests that the primary contribution to the vector based Z is from the tissue/water in proximity to the individual electrodes. This novel finding may help explain the limited utility of Z for detecting worsening HF.

Resumo Limpo

rational intrathorac imped z detect worsen heart failur hf presuppos chang z reflect chang pulmonari congest confound poor specif clinic trial therefor test hypothesi z primarili affect tissuewat content proxim electrod rather lung water distribut electrod use new comput model deriv nearfield imped contribut various electrod six sheep implant left atrial pressur lap monitor cardiac resynchron therapi devic measur z six vector compris five electrod vectorbas z model summat nearfield imped two electrod form vector volum expans acut increas lap result simultan reduct nearfield imped intracardiac electrod subcutan electrod show sever hour lag p contrast simul format devicepocket edema induc fluid inject nearfield imped subcutan electrod instantan respons intracardiac electrod minim inconsist respons studi suggest primari contribut vector base z tissuewat proxim individu electrod novel find may help explain limit util z detect worsen hf

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