Prognostic Utility of Impedance Cardiography Measurements in Elderly Hemodialysis Patients with Coronary Artery Disease

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hemodialysis with coronary artery disease (n=75). Intervention: Impedance cardiography measurements and diastolic blood pressure =60 mm Hg. Primary outcome: Cardiovascular mortality (HR 2.8, 95% CI 1.2-6.7).

Q: What does this research mean for the field?

Impedance cardiography accurately measures cardiac output compared to echocardiography, and diastolic blood pressure <60 mm Hg independently predicts cardiovascular mortality in elderly hemodialysis patients with coronary artery disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the accuracy and prognostic value of impedance cardiography measurements in elderly hemodialysis patients with coronary artery disease.

Dimitrios Karakitsos; Mitchell S. Wachtel; Nicolaos J. Zerefos; Dimitrios Valis; Alexandros Patrianakos; Theodosios Saranteas; Eugene Daphnis; John Boletis; Christodoulos Stefanadis; Andreas Karabinis

doi:10.1159/000174855

November 14, 2008American Journal of Nephrology

Prognostic Utility of Impedance Cardiography Measurements in Elderly Hemodialysis Patients with Coronary Artery Disease

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Key result

Impedance cardiography correlated with echocardiography (r=0.94, p<0.001), and diastolic blood pressure <60 mm Hg predicted cardiovascular mortality (HR 2.8; 95% CI 1.2-6.7).

Key Points

To evaluate the accuracy and prognostic value of impedance cardiography measurements in elderly hemodialysis patients with coronary artery disease.
Evaluated 75 hemodialysis patients (30 with coronary artery disease) using impedance cardiography to calculate cardiac output, systemic vascular resistance, and pulse pressure at baseline, 30 days, and 180 days.
Compared impedance cardiography cardiac output against echocardiography cardiac output and followed patients for up to 6 years for fatal cardiovascular events.
Identified independent predictors of cardiovascular mortality using Bayesian information criterion selection in multivariate Cox proportional hazards regression models.
Impedance cardiography cardiac output correlated strongly with echocardiography cardiac output (r = 0.94, p < 0.001) and inversely with pulse pressure (r = -0.61, p < 0.001).
During the 6-year follow-up, 30 fatal cardiovascular events occurred across the cohort.
Multivariate Cox regression identified increased pulse pressure, higher NYHA class, and decreased diastolic blood pressure as predictors of cardiovascular death, with diastolic blood pressure <60 mm Hg yielding a hazard ratio of 2.8 (95% CI = 1.2–6.7) when adjusted for NYHA class.

Study Design

Type

Cohort (n=75)

PICO

P

Population

75 elderly hemodialysis patients, including 30 with coronary artery disease, followed for 6 years.

E

Exposure / Comparator

Impedance cardiography measurements and diastolic blood pressure <60 mm Hg vs Echocardiography cardiac output / diastolic blood pressure >=60 mm Hg

O

Primary Outcome

Cardiovascular mortality — HR 2.8 (1.2-6.7)

Main Result

Hazard Ratio: 2.8 (95% CI 1.2–6.7)

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Implication

Shows impedance cardiography tracks cardiac output in hemodialysis patients with coronary disease, indicating low diastolic blood pressure predicts long-term cardiovascular mortality.

Abstract

AIM: We evaluated the utility of impedance cardiography (IC) in elderly hemodialysis (HD) patients with coronary artery disease (CAD). PATIENTS AND METHODS: Seventy-five HD patients (30 with CAD) participated. IC cardiac output (ICCO), systemic vascular resistance and pulse pressure (PP) were calculated at baseline, and 30 and 180 days after study entry. ICCO was compared to echocardiography cardiac output (ECO). Relationships of IC measurements and cardiovascular mortality were assessed. Patients were followed up for 6 years after study entry or until death due to cardiovascular events. RESULTS: ICCO and ECO were strongly correlated (r = 0.94, p < 0.001). ICCO correlated inversely with PP (r = -0.61; p < 0.001). Thirty fatal cardiovascular events were recorded. Using the bayesian' information criterion, multivariate Cox regression models revealed that increased PP and New York Heart Association (NYHA) class as well as decreased diastolic blood pressure (DBP) were predictors of cardiovascular mortality. Having a DBP <60 mm Hg (adjusted for NYHA) yielded a hazard ratio of 2.8 (95% confidence interval = 1.2-6.7). CONCLUSION: IC accurately estimates the hemodynamic status in HD patients with CAD. Deterioration of cardiovascular performance expressed by decreased DBP values, adjusted for NYHA, may help to predict outcome.

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Cite This Study

Karakitsos et al. (2008) conducted a cohort in Hemodialysis with coronary artery disease (n=75). Impedance cardiography measurements and diastolic blood pressure <60 mm Hg vs. Echocardiography cardiac output / diastolic blood pressure >=60 mm Hg was evaluated on Cardiovascular mortality (HR 2.8, 95% CI 1.2-6.7). Impedance cardiography correlated with echocardiography (r=0.94, p<0.001), and diastolic blood pressure <60 mm Hg predicted cardiovascular mortality (HR 2.8; 95% CI 1.2-6.7).

synapsesocial.com/papers/6a7ca808041f7ddee0ba6225 https://doi.org/10.1159/000174855

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Prognostic Utility of Impedance Cardiography Measurements in Elderly Hemodialysis Patients with Coronary Artery Disease

Key Points

Study Design

PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prognostic Utility of Impedance Cardiography Measurements in Elderly Hemodialysis Patients with Coronary Artery Disease

Key Points

Study Design

PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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