J Cardiovasc Med (Hagerstown). 2014 Apr;15(4):322-30. doi: 10.2459/01.JCM.0000435614.40439.21.
Optimization of inotropic treatment in worsening heart failure sometimes requires invasive hemodynamic assessment in selected patients. Impedance cardiography (ICG) may be useful for a noninvasive hemodynamic evaluation.
ICG was performed in 40 patients (69 ± 8 years; left ventricular ejection fraction 27.5 ± 5.6%; New York Heart Association 3.18 ± 0.34; Interagency Registry for Mechanically Assisted Circulatory Support 5.48 ± 0.96, before and after infusion of Levosimendan (0.1–0.2 µg/kg per min for up to 24 h). Echocardiogram, ICG [measuring cardiac index (CI), total peripheral resistances (TPRs) and thoracic fluid content (TFC)] and plasma levels of brain natriuretic peptide (BNP) were obtained; in nine patients, right heart catheterization was also carried out.
When right catheterization and ICG were performed simultaneously, a significant relationship was observed between values of CI and TPR, and between TFC and pulmonary wedge pressure. ICG detected the Levosimendan-induced recovery of the hemodynamic status, associated with improved systolic and diastolic function and reduction in BNP levels. One-year mortality was 4.4%. At multivariate analysis, independent predictors of mortality were: no improvement in the severity of mitral regurgitation, a persistent restrictive filling pattern (E/E’ > 15), a reduction of BNP levels below 30% and a change below 10% in CI, TPR and TFC. When combined, absence of hemodynamic improvement at ICG could predict 1-year mortality with better sensitivity (86%) and specificity (85%) than the combination of echocardiographic and BNP criteria only (sensitivity 80% and specificity 36%).
Noninvasive hemodynamic evaluation of heart failure patients during infusion of inodilator drugs is reliable and may help in their prognostic stratification.
在心力衰竭恶化时，优化正性肌力治疗有时需要在选定的患者中进行有创血流动力学评估。阻抗心动图（ICG）可用于非侵入性血流动力学评估。
在 40 名患者（69±8 岁；左心室射血分数 27.5±5.6%；纽约心脏协会 3.18±0.34；机械循环辅助支持机构间注册 5.48±0.96）中进行了 ICG 检查，在静脉输注左西孟旦（0.1-0.2μg/kg/min 持续 24 小时）前后进行了超声心动图、ICG[测量心指数（CI）、总外周阻力（TPR）和胸腔液体含量（TFC）]和脑钠肽（BNP）的血浆水平；在 9 名患者中还进行了右心导管检查。
当同时进行右心导管检查和 ICG 检查时，CI 和 TPR 之间以及 TFC 和肺楔压之间存在显著的相关性。ICG 检测到左西孟旦诱导的血流动力学状态恢复，与收缩和舒张功能改善以及 BNP 水平降低相关。1 年死亡率为 4.4%。多变量分析表明，死亡率的独立预测因素是：二尖瓣反流严重程度无改善、持续限制型充盈模式（E/E’>15）、BNP 水平降低低于 30%以及 CI、TPR 和 TFC 的变化低于 10%。当联合使用时，ICG 无血流动力学改善可预测 1 年死亡率，其敏感性（86%）和特异性（85%）优于仅联合超声心动图和 BNP 标准（敏感性 80%，特异性 36%）。
在输注正性肌力药物期间对心力衰竭患者进行非侵入性血流动力学评估是可靠的，并且可能有助于对其进行预后分层。
