Abstract presented at the British Pharmacological Society Winter Meeting in December 2006 and as a Poster at the European Society of Cardiology Heart Failure congress in Hamburg, June 2007.
MJ Ng Kam Chuen, GYH Lip, RJ MacFadyen, (RE Ferner)
Introduction: Intravenous furosemide (ivF) remains the first line treatment for pulmonary oedema (1) yet individual patient response to ivF is variable (2, 3). There is a need for an accurate, non-invasive means to define volume response to ivF, so that the role of alternative or additional treatments can be addressed.
Methods: We studied patients presenting with florid pulmonary oedema treated with bolus ivF (50-100 mg). We compared echocardiographic and Bodystat Quadscan4000 bioimpedance (BIA) volume estimates at 0, 0.5, 1, 2 and 3 hours from baseline.
Results: 31 patients (n=31; 18 male; 13 female; age 71.6±11.9, range 30-86; body surface area 1.86+/-0.22 m2, range 1.37-2.30; 23 sinus rhythm, 8 atrial fibrillation; 13 ischaemia, 2 arrhythmia, 4 valvular heart disease, 3 lung disease, 3 renal disease, 2 non-ischaemic cardiomyopathy, 3 hypertension, 1 infection) were studied. Early transmitral deceleration time (MV DecT), peak early transmitral velocity following valsalva manoeuvre (vMVPeakE), peak early transtricuspid velocity (TVPeak E), inferior vena cava diameter corrected for body surface area in expiration (IVCei) and in inspiration (IVCii), whole body impedance at frequencies 5-200 KHz (Ω5KHz, Ω50KHz, Ω100KHz, Ω200KHz) were the most sensitive parameters to define volume response to ivF in typical patients with pulmonary oedema (Table 1).
| Parameter | n | Baseline | Maximal response | Maximal change (% baseline) | Maximal response time (h) | |
| MV DecT(ms) | 30 | 204+/-72 | 244+/-92 | 23.9+/-33.5 | 3 |
P=0.029 |
| vMVPeakE(m/s) | 27 | 1.09+/-0.29 | 0.97+/-0.26 | 9.5+/-19.3 |
2 |
P=0.025 |
| TV PeakE(m/s) | 27 | 0.77+/-0.22 | 0.67+/-0.21 | 11.9+/-13.5 | 1 |
P=0.010 |
| IVCei(cm/m2) | 28 | 1.23+/-0.33 | 1.14+/-0.31 | 4.8+/-21.6 | 3 | P=0.024 |
| IVCii(cm/m2) | 27 | 1.08+/-0.30 | 0.97+/-0.27 | 7.3+/-26.5 | 3 | P=0.005 |
| d Ω5KHz(Ω) | 31 | 497+/-147 | 518+/-160 | 4.1+/-6.3 | 3 | P=0.000 |
| d Ω50KHz(Ω) | 31 |
451+/-131 |
466+/-140 | 3.6+/-7.3 | 3 | P=0.005 |
|
d Ω100KHz(Ω) |
31 | 431+/-126 | 447+/-132 | 4.3+/-9.7 | 3 | P=0.008 |
| d Ω200KHz(Ω) | 31 | 412+/-124 | 426+/-125 | 5.0+/-15.3 | 3 | P=0.047 |
Conclusion: Given the complexity of presentation with pulmonary oedema, the above measurements of volume response could be applied to optimise response to treatment