Lung Impedance Guided Therapy Reduces Hospitalizations in Heart Failure with Preserved Ejection Fraction: A Randomized Trial
In brief
Lung impedance monitoring cuts heart-failure admissions by about 80% in preserved EF
In a single-center trial of 150 HFpEF patients, monthly lung-impedance guided therapy reduced recurrent heart-failure hospitalizations from 95 events to 20, a roughly 80% drop, and also lowered all-cause and HF-specific mortality. Benefit came from earlier, more precise diuretic adjustments, suggesting a new tool for fluid management, though larger multicenter studies are needed.
- Journal
- Journal of cardiac failure (Q1)
- Published
- 12 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Michael Kleiner Shochat, Marat Fudim, Ilia Kleiner, Alexander Rabinovich, Guy Rozen, Gurusher Panjrath, et al.
- PMID
- 42586362
- DOI
- 10.1016/j.cardfail.2026.07.019
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 16 August 2026): Lung impedance‑guided therapy reduces HFpEF hospitalizations
Abstract
BACKGROUND: Prior studies demonstrated that lung impedance (LI)-guided therapy reduces heart failure (HF) hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: In this proof-of-concept, single-blind, single-center randomized controlled trial (NCT02661841), 150 HFpEF patients (NYHA class I-IV, LVEF >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<0.001; 20 vs 95 events). All-cause mortality (HR 0.40; 95% CI 0.18-0.87; p=0.02) and HF-specific mortality (HR 0.26; 95% CI 0.08-0.80; p=0.02) 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<0.001, achieved through earlier treatment escalation (median LIR -20.8% vs -35.4%; p<0.01) and more conservative de-escalation (-13.7% vs -2.3%; p<0.01). Diuretic adjustment efficacy was similar between groups (LIR improvement +1.01% vs +1.36%; p=0.63), confirming benefit derived from precision timing rather than superior drug response. CONCLUSIONS: In this proof-of-concept randomized trial, LI-guided management significantly reduced HF hospitalizations, all-cause mortality, and HF-specific mortality in HFpEF through precision timing of decongestion.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.