4.32 A Non-Invasive Method to Assess Haemodynamic Variations in Patients with Chronic Heart Failure
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Heart 4.32 A Non-Invasive Method to Assess Haemodynamic Variations in Patients with Chronic Heart Failure A. Giglio,1 S. Blengino,2 G. Malfatto,2 S. Boarin,2 G. Branzi,2 A. Villani,2 G. Perego,2 M. Revera,1 G. Bilo,1 G. Mancia,1 G. Parati1 (1) Univ.Milano-Bicocca, Istituto Auxologico Italiano, Mi Milan; (2) Istituto Auxologico Italiano, Milan, It Italy Introduction: Chronic heart failure (CHF), a severe complication of hypertension, is a major health problem of ever-increasing proportions which limits patients’ functional capacity, carries a high rate of morbid and fatal events and often requires hospitalisation. Optimisation of treatment through assessment of haemodynamic parameters is a rational and accepted indication to right heart catheterization (RC) in CHF, a procedure not free from risks, however, due to its invasiveness. The need of repeated haemodynamic studies during follow-up makes such invasive procedure even less suitable to routine clinical management of CHF patients. Among alternative non invasive methods, impedance cardiography was in the past suggested to provide useful information, with conflicting results, however. This approach has been recently reconsidered due to progress in technology, but limited evidence on its present value is available. Objective: Aim of our ongoing study is to explore the value of a new non-invasive method based on bioimpedance cardiography (IM) to assess haemodynamic variations over time in CHF patients as compared to invasive assessment. Methods: We have until now studied 6 patients with either ischaemic or non-ischaemic dilated cardiomyopathy and systolic dysfunction (ejection fraction < 35%, age 72+5; 3 males, NYHA class III-IV). All patients presented signs and symptoms of decompensated CHF at entry. In all patients RC, IM (CardioDynamics, BioZ.com) and Brain Natriuretic Peptide (BNP) assessment (an index of ventricular dysfunction and of high ventricular filling pressures) were simultaneously performed. Results: There was a high correlation between values of Cardiac Output (CO, r =0.92), Cardiac index (CI, r= 0.85), and systemic vascular resistance index (SVRI, r =0.92) provided by RC and IM, a close correspondence supported also by Bland-Altman analysis. Total Thoracic Conductivity (TTC), an index of thoracic congestion measured by IM, was closely related to BNP levels (r =0.84). Conclusion: Our preliminary data demonstrate the reliability of IM as an alternative approach to invasive RC in the haemodynamic follow-up of CHF patients, aimed at monitoring the stability of their clinical conditions and at guiding treatment over time.
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