Lung Impedance-Guided Therapy Reduces Hospitalizations in Heart Failure with Preserved Ejection Fraction: A...

Prior studies demonstrated that lung impedance (LI)-guided therapy reduces heart failure (HF) hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF).

In this proof-of-concept, single-blind, single-center randomized controlled trial (NCT02661841), 150 HFpEF patients (New York Heart Association class I-IV, left ventricular ejection fraction >50%, elevated NT-proBNP, prior HF hospitalization) were randomized 1:1 to LI-guided management or usual care. LI was measured noninvasively at monthly outpatient visits using the FDA-approved CardioSet device. The primary endpoint was recurrent HF hospitalization. Mean follow-up was 38.4 ± 22.8 months. HF hospitalizations were significantly reduced in the LI-guided group (HR 0.26; 95% CI 0.14-0.49; P < .001; 20 vs. 95 events). All-cause mortality (HR 0.40; 95% CI 0.18-0.87; P =.02) and HF-specific mortality (HR 0.26; 95% CI 0.08-0.80; P = .02) were also significantly lower. The lung impedance ratio (LIR), reflecting each patient's degree of pulmonary congestion relative to their individual normal dry state, was used as a real-time fluid index to assess fluid status and guide diuretic titration at each visit. LI-guided patients spent significantly more time within the therapeutic LIR range, median 97% vs. 49%; P < .001, achieved through earlier treatment escalation (median LIR -20.8% vs. -35.4%; P < .01) and more conservative de-escalation (-13.7% vs. -2.3%; P < .01). Diuretic adjustment efficacy was similar between groups (LIR improvement +1.01% vs. +1.36%; P = .63), confirming benefit derived from precision timing rather than superior drug response.

In this proof-of-concept randomized trial, LI-guided management significantly reduced HF hospitalizations, all-cause mortality, and HF-specific mortality in HFpEF through precise timing of decongestion.