Lung Impedance-Guided Therapy Shows Promise in HFpEF, Suggests Study
Israel: A small trial suggests that outpatient lung impedance-guided therapy may be beneficial for patients with heart failure with preserved ejection fraction (HFpEF). The approach showed potential for guiding management outside the hospital and may help improve heart-failure care, although larger studies are needed to confirm its clinical effectiveness.
The study, published in the Journal of Cardiac Failure, was led by Michael Kleiner Shochat of the Heart Institute, Hillel Yaffe Medical Center, Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Hadera, Haifa, Israel, and colleagues. The researchers investigated whether monitoring lung impedance (LI) could help clinicians identify changes in fluid status earlier and adjust diuretic treatment more precisely.
HFpEF is characterized by symptoms of heart failure despite a relatively preserved left ventricular ejection fraction. Managing congestion can be challenging because fluid accumulation may develop gradually and contribute to worsening symptoms and hospitalization. Previous research has shown benefits of LI-guided management in patients with heart failure with reduced ejection fraction, but its role in HFpEF has been less established.
The proof-of-concept, single-blind, single-center randomized trial enrolled 150 patients with HFpEF. Participants had a left ventricular ejection fraction above 50%, elevated NT-proBNP levels, and a history of hospitalization for heart failure. They were randomly assigned to either LI-guided management or usual care and followed for an average of 38.4 months.
Lung impedance was measured noninvasively during monthly outpatient visits using the FDA-approved CardioSet device. Researchers used the Lung Impedance Ratio (LIR), which reflects changes in pulmonary congestion relative to each patient's individual dry-state level, to monitor fluid status and guide diuretic adjustments.
- HF hospitalizations were substantially lower with LI-guided management, with 20 events compared with 95 in the usual-care group (HR 0.26).
- All-cause mortality was also lower in the LI-guided group (HR 0.40).
- HF-specific mortality was reduced as well (HR 0.26).
- Patients receiving LI-guided care remained within the target LIR range for a median of 97% of follow-up, compared with 49% with usual care.
The researchers found that the advantage was not due to diuretics working better in the LI-guided group. Improvement in LIR after diuretic adjustment was similar between groups. Instead, the benefit appeared to result from more precise timing of treatment changes, including earlier escalation when congestion increased and more cautious reduction of therapy.
The investigators described the findings as proof-of-concept evidence supporting further evaluation of LI-guided management in HFpEF. Larger, multicenter studies will be needed to determine whether this strategy can reliably reduce hospitalizations and improve long-term outcomes in broader HFpEF populations.
Reference:
Shochat, M. K., Fudim, M., Kleiner, I., Rabinovich, A., Rozen, G., Panjrath, G., Barel, M. S., Margolis, G., Roguin, A., & Meisel, S. R. (2026). Lung Impedance Guided Therapy Reduces Hospitalizations in Heart Failure with Preserved Ejection Fraction: A Randomized Trial. Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2026.07.019
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