Recurrent Episodes of Fluid Retention in a Patient with Heart Failure and Chronic Kidney Disease: The Additional Value of Implantable Monitoring Systems

<div>Daily averaged ePAD (mmHg) vs. intrathoracic impedance (<span class="nowrap"><svg height="9.01194pt" id="M3" style="vertical-align:-0.04981995pt" version="1.1" viewbox="-0.0498162 -8.96212 9.12937 9.01194" width="9.12937pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M669 636L663 650H260C230 650 221 652 208 675H186C177 621 162 548 144 481L173 479C195 534 211 560 226 578C248 604 266 615 373 615H544C460 511 114 112 23 16L31 0H561C577 34 611 135 622 170L594 182C566 125 544 88 515 65C481 38 416 35 319 35C249 35 197 37 152 41C270 184 542 501 669 636Z"></path></g></svg>;</span> <i>Ω</i>). Two subpopulations of points relating ePAD to <svg height="9.01194pt" id="M4" style="vertical-align:-0.04981995pt" version="1.1" viewbox="-0.0498162 -8.96212 9.12937 9.01194" width="9.12937pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M669 636L663 650H260C230 650 221 652 208 675H186C177 621 162 548 144 481L173 479C195 534 211 560 226 578C248 604 266 615 373 615H544C460 511 114 112 23 16L31 0H561C577 34 611 135 622 170L594 182C566 125 544 88 515 65C481 38 416 35 319 35C249 35 197 37 152 41C270 184 542 501 669 636Z"></path></g></svg> coupled to episodes before (grey) and during dialysis (black) can be identified. A significant relation (<span class="nowrap"><svg height="8.69875pt" id="M5" style="vertical-align:-0.3499298pt" version="1.1" viewbox="-0.0498162 -8.34882 49.9544 8.69875" width="49.9544pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M393 379C402 394 400 411 393 422C384 437 365 448 348 448C301 448 237 372 186 285H182L193 335C210 408 205 448 178 448C150 448 80 402 29 344L45 321C80 355 114 373 122 373C128 373 130 365 124 330C106 228 76 98 50 -5L57 -12C82 -5 112 3 132 6L172 203C196 256 234 304 254 329C275 355 293 367 306 367C318 367 330 360 342 348C347 343 355 343 365 350S386 367 393 379Z"></path></g><g transform="matrix(.013,0,0,-0.013,9.12,0)"><path d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"></path></g><g transform="matrix(.013,0,0,-0.013,20.383,0)"><path d="M535 230V280H52V230H535Z"></path></g><g transform="matrix(.013,0,0,-0.013,28.014,0)"><path d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"></path></g><g transform="matrix(.013,0,0,-0.013,34.254,0)"><path d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"></path></g><g transform="matrix(.013,0,0,-0.013,37.218,0)"><path d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"></path></g><g transform="matrix(.013,0,0,-0.013,43.458,0)"><path d="M137 343C167 482 260 545 321 574C357 591 397 603 429 609L423 641C382 634 335 622 295 608C189 570 37 457 37 238C37 84 125 -12 242 -12C362 -12 447 89 447 209C447 311 374 393 267 393C247 393 226 386 204 376L137 343ZM227 337C318 337 361 256 361 173C361 105 336 22 258 22C176 22 126 120 126 240C126 266 127 291 132 310C155 323 189 337 227 337Z"></path></g></svg>)</span> but with only a moderate negative slope (-0.31) was found between ePAD and <svg height="9.01194pt" id="M6" style="vertical-align:-0.04981995pt" version="1.1" viewbox="-0.0498162 -8.96212 9.12937 9.01194" width="9.12937pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M669 636L663 650H260C230 650 221 652 208 675H186C177 621 162 548 144 481L173 479C195 534 211 560 226 578C248 604 266 615 373 615H544C460 511 114 112 23 16L31 0H561C577 34 611 135 622 170L594 182C566 125 544 88 515 65C481 38 416 35 319 35C249 35 197 37 152 41C270 184 542 501 669 636Z"></path></g></svg> before dialysis (<svg height="8.55521pt" id="M7" style="vertical-align:-0.2063904pt" version="1.1" viewbox="-0.0498162 -8.34882 42.5389 8.55521" width="42.5389pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M495 86L479 114C446 82 419 66 409 66C401 66 401 72 406 97C420 166 436 231 453 297C489 435 454 448 428 448C406 448 384 439 354 422C305 394 222 327 161 247H159L183 345C200 415 194 448 173 448C143 448 82 410 23 351L38 325C64 349 95 371 105 371C111 371 116 365 109 336L25 -4L31 -12C50 -4 77 3 107 9C119 69 132 122 145 168C197 254 321 381 370 381C387 381 393 374 378 305L329 95C309 17 320 -12 345 -12C372 -12 430 19 495 86Z"></path></g><g transform="matrix(.013,0,0,-0.013,10.158,0)"><path d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"></path></g><g transform="matrix(.013,0,0,-0.013,21.421,0)"><path d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"></path></g><g transform="matrix(.013,0,0,-0.013,27.661,0)"><path d="M249 635C141 635 70 555 70 471C70 401 114 353 179 316C143 294 106 267 90 252C68 231 45 202 45 157C45 50 130 -12 237 -12C322 -12 435 52 435 169C435 256 372 304 303 343C349 374 375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"></path></g><g transform="matrix(.013,0,0,-0.013,33.901,0)"><path d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"></path></g></svg>days). During dialysis, a stronger negative relation was observed (<span class="nowrap"><svg height="8.69875pt" id="M8" style="vertical-align:-0.3499298pt" version="1.1" viewbox="-0.0498162 -8.34882 49.9544 8.69875" width="49.9544pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M393 379C402 394 400 411 393 422C384 437 365 448 348 448C301 448 237 372 186 285H182L193 335C210 408 205 448 178 448C150 448 80 402 29 344L45 321C80 355 114 373 122 373C128 373 130 365 124 330C106 228 76 98 50 -5L57 -12C82 -5 112 3 132 6L172 203C196 256 234 304 254 329C275 355 293 367 306 367C318 367 330 360 342 348C347 343 355 343 365 350S386 367 393 379Z"></path></g><g transform="matrix(.013,0,0,-0.013,9.12,0)"><path d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"></path></g><g transform="matrix(.013,0,0,-0.013,20.383,0)"><path d="M535 230V280H52V230H535Z"></path></g><g transform="matrix(.013,0,0,-0.013,28.014,0)"><path d="M241 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375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"></path></g></svg>;</span> <span class="nowrap"><svg height="12.4764pt" id="M9" style="vertical-align:-3.1685pt" version="1.1" viewbox="-0.0498162 -9.3079 71.4979 12.4764" width="71.4979pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M319 325C317 349 306 409 297 431C277 440 250 449 209 449C117 449 57 389 57 319C57 243 122 209 182 182C232 159 261 135 261 91C261 48 227 21 190 21C130 21 85 79 68 145L41 140C41 104 51 36 58 22C75 7 121 -12 172 -12C252 -12 337 35 337 126C337 195 286 231 210 262C166 281 126 304 126 348C126 388 152 417 191 417C240 417 274 378 294 318L319 325Z"></path></g><g transform="matrix(.013,0,0,-0.013,4.719,0)"><path 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Case Reports in Cardiology

fig3

Figure 3

Figure 3: Recurrent Episodes of Fluid Retention in a Patient with Heart Failure and Chronic Kidney Disease: The Additional Value of Implantable Monitoring Systems 

Figure 3 | Recurrent Episodes of Fluid Retention in a Patient with Heart Failure and Chronic Kidney Disease: The Additional Value of Implantable Monitoring Systems 