| 유병수¹, 왕희성¹ , 정일형¹ , 이미영¹ , 정현숙¹ ,김장영 ¹ , 이승환¹ , 황성오² ,윤정한¹ ,최경훈 ¹ |
Background: Impedance cardiography (ICG) is a newly validated method of determining hemodynamic parameters noninvasively. A simple noninvasive method would be desirable in the clinical evaluation and management of patients with HF. We evaluate clinical usability of ICG parameters in patients with acute exacerbation of systolic heart failure (SHF).
Methods: Between Feb. 2004 and Aug. 2004, 34 patients in whom acute exacerbation of SHF was admitted, were included. As control group, 18 of normal persons also were included. We performed echocardiography, hemodynamic monitoring with BioZ ICG monitor (CardioDynamics, San Diego, CA) according to the manufacturer’s guidelines. A data listing the following ICG hemodynamic parameters was obtained: stroke index(SI), cardiac index(CI), systemic vascular resistance index(SVRI), and total fluid content(TFC). In 8 of SHF patients, swan-ganz catheterization was performed invasively. Criteria for ICG-derived heart failure were defined as either a CI ≤2.4 or STR≥0.55 concurrent with a CI <3.0L/min/m2.
Results: Mean age of total subjects (n=52) was 59.3±14 and male was 44.2% (n=23). In SHF group (n=34), mean age was 65.0±10.9, male was 41.2% and in control group (n=18), 48.4±13.1, male 50%. Between two groups, there were significant difference (p<0.05) in following parameters; CI (2.69±0.33 vs. 2.13±0.7 L/min/m2), TFC (28.1±1.72 vs. 38.01±8.4/kOhm),and STR (0.32±0.04 vs. 0.47±0.2). When pulmonary congestion was exist on plain chest film (n=23), ICG showed significantly higher value of TFC than heart failure patients without congestion (p=0.028). There were significant relation between the data by ICG and swan-ganz catheterization in CI (r=0.85, p=0.030). In patients with SHF, there was significant correlation between EF and STR from ICG data (p=0.029, r=0.529). Diagnostic criteria for ICG-derived heart failure showed sensitivity 88.9%, specificity 60.0% in diagnosing SHF compare to echocardiography. Conclusions: We thought that ICG would be relatively useful method in differentiating SHF and provided useful information for hemodynamic parameters and volume status in patients with acute exacerbation of SHF.
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