Coronary artery diseaseUsefulness of Lung Impedance-Guided Pre-Emptive Therapy to Prevent Pulmonary Edema During ST-Elevation Myocardial Infarction and to Improve Long-Term Outcomes
Section snippets
Methods
This randomized 2-center study included patients admitted to the coronary care unit for STEMI without signs of acute heart failure on admission, i.e., with no dyspnea, at Killip class I with a normal chest x-ray, and without previous heart failure. During hospitalization, repeated lung auscultations were done, and respiratory rate, heart rate, blood pressure, and oxygen saturation were recorded every hour. Diagnosis of PED was based on chest x-rays and a modified Killip classification: class I,
Results
In the preliminary phase of the study, we evaluated 65 patients with STEMI (60 ± 12 years old) who had no clinical (Killip class I) or radiographic signs of PED at admission. During 72 hours of monitoring 33 patients with STEMI did not develop clinical and radiologic signs of PED and another 32 well-matched monitored patients developed PED (Killip classes IIA to IV). LI decreased in the former group during hospitalization by 0% to 14% from the initial value and in the latter group by 12% to 27%
Discussion
Current guidelines categorize acute heart failure into 6 different overlapping presentations,11 with PED in the course of AMI an important exception because it is a relatively uniform syndrome, especially for de novo acute heart failure. In this study we have reconfirmed our previous findings regarding LI changes throughout the evolution of PED in patients with STEMI and used LI as a trigger to initiate pre-emptive treatment. Use of a monitored signal to instigate therapy for evolving PED is of
Acknowledgment
We acknowledge the nursing staff and echocardiographic technicians of the Heart Institute, Hillel Yaffe Medical Center for their valuable contribution.
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2021, Revista Portuguesa de CardiologiaCitation Excerpt :Net lung impedance, which is the impedance of interest, comprises only a small fraction of the overall transthoracic impedance.20 Subtraction of the chest wall impedance from the transthoracic impedance yields the net lung impedance.24,25 Moreover, usually as we have already pulmonary congestion in patients with HF when we are assessing them for the first time, sometimes it is not possible to determine the baseline lung impedance (BLI) but rather the instantaneous lung impedance (ILI).
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Dr. Shochat and Dr. Rabinovich are members of the advisory board of the RSMM Company, Tel Aviv, Israel.