Journal of Geriatric Cardiology 2012/9:4 PP.321-327
Objective To evaluate the efficacy of preventive treatment (PT) on alveolar pulmonary edema (APE) of cardiogenic origin using a monitor based on principles of internal thoracic impedance (ITI) measurements. Methods We conducted blinded clinical trials on patients with ST-elevation myocardial infarction (STEMI) and monitored whether the condition would progress to APE. ITI was measured non- invasively by the Edema Guard Monitor (EGM, model RS-207) every 30 min. The measurement threshold for the diagnosis of APE was fixed at > 12% decrease in ITI from baseline as described in our methodology. The patients were divided into one group that received standard treatment after the appearance of clinical signs of APE without considering the prediction of APE by EGM devise (Group 1), and another group of asymptomatic patients in whom development of APE was predicted by using only EGM measurements (Group 2). The latter participants’ PT consisted of furosemide, intravenous nitroglycerine and supplemental oxygen. Results One-hundred and fifty patients with acute STEMI were enrolled into this study. Group 1 included 100 patients (53% males, age 64.1 ± 12.6 years). Treatment was started after the clinical appearance of overt signs of APE. Group 2 included 50 patients (54% males, age 65.2 ± 11.9 years) who received PT based on EGM measurements. Group 2 had significantly fewer cases of APE (n = 4, 8%) than Group 1 (n = 100, 100%) (P > 0.001). While APE was lethal in six (6%) Group 1 patients, PT resulted in prompt resolution of APE in all four (8%) Group 2 patients. Conclusion ITI is a useful modality for early diagnosis and PT of pulmonary edema of cardiogenic origin.
1 Shochat M, Shotan A, Blondheim DS, et al. Usefulness of lung impedance-guided pre-emptive therapy to prevent pulmonary edema during ST-elevation myocardial infarction and to improve long-term outcomes. Am J Cardiol 2012; 110: 190-196.
2 Cotter G, Moshkovitz Y, Milovanov O, et al. Acute heart failure: a novel approach to its pathogenesis and treatment. Eur J Heart Fail 2002; 4: 227-234.
3 Fein A, Grossman RF, Jones G, et al. Evaluation of transthoracic electrical impedance in the diagnosis of pulmonary edema. Circulation 1979; 60: 1156-1160.
4 Saunders CE. The use of transthoracic electrical bioimpedance in assessing thoracic fluid status in emergency department patients. Am J Emerg Med 1988; 6: 337-340.
5 Spinale FG, Reines HD, Cook MC, et al. Noninvasive estimation of extravascular lung water. J Surg Res 1989; 47: 535- 540.
6 Campbell JH, Harris ND, Zhang F, et al. Prediction of changes in intrathoracic fluid in man using electrical impedance tomography. Clin Sci (Lond) 1994; 87: 97-101.
7 Newell JC, Edis PM, Ren X, et al. Assessment of acute pulmonary edema in dogs by electrical impedance imaging. IEEE Trans Biomed Eng 1996; 43: 133-138.
8 Nierman DM, Eisen DI, Fein ED, et al. Transthoracic bioimpedance can measure extravascular lung water in acute lung injury. J Surg Res 1996; 65: 101-108.
9 Kubicek WG, Patterson RP, Witsoe DA. Impedance cardiography as a noninvasive method of monitoring cardiac function and other parameters of the cardiovascular system. Ann NY Acad Sci 1970; 170: 724-731.
10 Staub NC, Hogg JC. Conference report of a workshop on the measurement of lung water. Crit Care Med 1980; 8: 752-759.
11 Miniati M, Pistolesi M, Milne EN, et al. Detection of lung edema. Crit Care Med 1987; 15: 1146-1155.
12 Yamamoto T, Yamamoto Y. Electrical properties of the epidermal stratum corneum. Med Biol Eng 1976; 14: 151-158.
13 Yamamoto Y, Yamamoto T. Characteristics of skin admittance for dry electrodes and measurement of skin moisture. Med Biol Eng Comput 1986; 24: 71-77.
14 Itoh M. Apparatus for Measuring a Pulmonary Function. US Patent 4269195, 1981.
15 Yu CM, Wang L, Chau E, et al. Intrathoracic impedance monitoring in patients with heart failure. Circulation 2005; 112: 841-848.
16 Charach G, Rabinovich P, Grosskopf I, et al. Transthoracic monitoring of the impedance of the right lung in patients with cardiogenic pulmonary edema. Crit Care Med 2001; 29: 1137- 1144.
17 Shochat M, Meisel S, Rabinovich P, et al. Monitoring of the internal thoracic impedance: a novel method to detect pulmonary edema before appearance of clinical signs. J Am Coll Cardiol 2003 (Suppl. to 52nd Annual Scientific Session); 1206-1273.
18 Shochat M, Meisel S, Rabinovich P, et al. A new method for detecting cardiogenic pulmonary edema before appearance of clinical signs and for the evaluation of treatment efficacy. J Am Coll Cardiol 2004 (Suppl. to 53nd Annual Scientific Session); 1154-1196.
19 Shochat M, Charach G, Frimerman A, et al. Internal thoracic impedance monitoring: a new prospect in acute heart failure [abstract]. Eur Heart J 2004; 25 (Suppl): 500.
20 Shochat M, Kazatzker M, Charach G, et al. Internal thoracic impedance monitoring: a new tool for the early diagnosis and treatment of acute heart failure [abstract]. Eur J Heart Fail 2005; 4 (Suppl 1): 79-80.
21 Shochat M, Charach G, Meyler S, et al. Internal thoracic impedance monitoring: a novel method for the early detection of cardiogenic pulmonary congestion at the pre-clinical stage. Cardiovasc Revasc Med 2006; 7: 41-45.
22 Shochat M, Charach G, Meyler S, et al. Prediction of cardiogenic pulmonary edema onset by monitoring right lung impedance. Intensive Care Med 2006; 32: 1214-1221.
23 Braumwald E, Colcci S, Grossman W. Clinical aspects of heart failure. High output heart failure. In Heart Diseases, 6th Edition; Braumwald E, Ed.; WB Saunders: New York, USA 1997; Volume 1, 177.
24 Massie BM, Amidon TM. Acute pulmonary edema: essentials of diagnosis. In Current Medical Diagnosis and Treatment; Tierney LM, McPhee SJ, Stephen J, Eds.; Appleton & Lange: Stamford, CT, USA, 1998; 412.
25 Cropper MA, Wiener-Kronish JP, Hashimoto S. Acute cardiogenic pulmonary edema. Clin Chest Med 1994; 15: 501- 515.
26 Verma SP, Silke B, Hussain MG, et al. First-line treatment of left ventricular failure complicating acute myocardial infarction: a randomized evaluation of immediate effects of diuretic, venodilator, arteriodilator, and positive inotropic drugs on left ventricular function. J Cardiovasc Pharmacol 1987; 10: 38-46.
27 Mantle JA, Russell RO Jr., Moraski RE, et al. Isosorbide dinitrate for the relief of severe heart failure after myocardial infarction. Am J Cardiol 1976; 37: 263-268.