Non-invasive home lung impedance monitoring in early post-acute heart failure discharge: Three case reports

Table 1 Patients’ demographics, medical history and length of hospital stay

	Patient 1	Patient 2	Patient 3
Age	66	62	83
Gender	Male	Male	Female
Medical history
Arterial hypertension	+	+	+
Kidney disease	+	+	+
Myocardial infarction	+	+	+
Revascularization	+	+	+
Atrial fibrillation	-	+	-
Implanted devices	Biventricular pacemaker	Biventricular defibrillator	-
Length of stay (d)	6	17	15

Table 2 The dynamics of laboratory tests, echocardiography parameters, lung impedance, weight and medications throughout 30 d

Characteristics	Patient 1		Patient 2		Patient 3
	Discharge	After 30 d	Discharge	After 30 d	Discharge	After 30 d
Laboratory tests
NT-proBNP (ng/L)	109	179	3485	2061	2927	5398
Troponin I (ng/L)	13.5	15.4	50.2	20.8	168.0	25.1
Potassium (mmol/L)	5.2	6.3	4.7	4.0	5.1	4.2
Sodium (mmol/L)	139	138	139	139	137	143
Chlorine (mmol/L)	100	95	101	98	98	103
Creatinine (mkmol/L)	133	282	96	103	111	118
eGFR (mL/min per 1.73 m2)	48	19	73	68	40	37
Echocardiography
LV diastolic diameter (mm)	59	56	76	76	71	71
LV ejection fraction 2D (%)	29	27	20	28	23	30
LV ejection fraction 3D (%)	26	29	19	25	35	23
Cardiac output (L/min) 2D	3.1	3.43	4.14	4.68	4.1	3.9
Cardiac output (L/min) 3D	1.7	2.2	4.4	4	4.3	2.2
LV stroke volume 2D (mL)	36	47	41	52	48	58
PCWP (by Nagueh, mmHg)	9.34	12.7	21.0	17	13.0	8.2
Global longitudinal 2D strain (%)	-7	-8.8	-6	-3.6	-6.2	-7.7
Right ventricular diameter (cm)	3.3	3.8	5.2	5.3	2.3	1.9
RV S’ (cm/s)	9	11	7	10	15	14
TAPSE (cm)	1.7	1.9	0.6	1.6	2.1	1.9
RV FAC (%)	32.3	35	16.6	28.8	49.6	74.8
Lung impedance (Ω)	88.6	93.0	107.9	97.1	101.8	88.1
Weight (kg)	80	81.3	104	105	60.0	61.8
Medicatio
Percentage of target dose of beta-blocker	25%	50 %	100 %	100%	25%	25%
Percentage of target dose of ACEI	100%	100%	12.5%	25%	50%	25%
Percentage of target dose of Spironolactone	50%	-	50%	100%	100%	-
Torasemide daily dose (mg)	50 mg (e.s.d.)	10 mg	50 mg	100 mg	25 mg	10 mg

NT-proBNP: N-terminal pro B-type natriuretic peptide; eGFR: Estimated glomerular filtration rate; LV: Left ventricular; PCWP: Pulmonary capillary wedge pressure; RV S’: Systolic velocity of tricuspid valve; TAPSE: Tricuspid annular plain systolic excursion; FAC: Fractional area change; ACEI: Angiotensin-converting enzyme inhibitor.

Table 3 Triggers for treatment adjustments reacting to clinical and monitoring parameters

Trigger	Intervention	Frequency of intervention, times
Symptoms (weakness)	Hospitalization because of revealed renal failure, hyperkalemia	1
High HR	Increasing the dose of beta-blockers	3
	Administration of Ivabradine	1
Uncontrolled BP	Increasing the dose of ACE inhibitors	1
Electrolyte imbalance	Increasing the dose of Spironolactone and decreasing the dose of Torasemide	1
LI decrease	Increasing the dose of beta-blockers and Spironolactone	1
	Increasing the dose of ACE inhibitors and beta-blockers	1
	Increasing the dose of Torasemide	5
Weight gain	-	0

HR: Heart rate; BP: Blood pressure; LI: Lung impedance; ACE: Angiotensin-converting enzyme.