Recurrent Episodes of Fluid Retention in a Patient with Heart Failure and Chronic Kidney Disease: The Additional Value of Implantable Monitoring Systems

Figures

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  Figure 1. (a) Daily averaged estimated pulmonary artery diastolic pressure (ePAD). (b) Intrathoracic impedance (Ω) with reference line (dotted). (c) Diuretic dose (bumetanide, mg/day). AE: adverse event. Dashed lines indicate loss of long-term trend data because of remote patient hospitalization and noncompliance.

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  Figure 2. (a) ePAD (mmHg). (b) Intrathoracic impedance (Ω) with reference line (dotted). (c) Diuretic dose (bumetanide, mg/day). AE: adverse event. Dashed line indicates loss of ePAD data.

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  Figure 3. Daily averaged ePAD (mmHg) vs. intrathoracic impedance (Z; Ω). Two subpopulations of points relating ePAD to Z coupled to episodes before (grey) and during dialysis (black) can be identified. A significant relation (r = −0.56) but with only a moderate negative slope (-0.31) was found between ePAD and Z before dialysis (n = 282 days). During dialysis, a stronger negative relation was observed (r = −0.68; slope = −1.71, n = 179 days).

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  Figure 4. (a, b) Relation between maximum positive right ventricular dP/dt and diastolic pressure (ePAD). Two scatter diagrams show the relation between RV diastolic pressure (mmHg) and maximum dP/dt (mmHg/s) before ((a), grey) and after hemodialysis ((b), black). (c) Slope of the Frank-Starling curve obtained within a sliding window of 30 days. A positive F-S slope indicates an increase in maximum RV dP/dt (mmHg/s) at higher RV diastolic pressures (mmHg). Dashed lines indicate missing ePAD data. The arrow indicates the time frame of hemodialysis.