Evaluation of thoracic impedance trends for implant-based remote monitoring in heart failure patients - Results from the (J-)HomeCARE-II Study
| Autor: | Kenji Ando, Marcus L. Koller, Burghard Schumacher, Aurelio Quesada, Stefan Paule, Nicole Lobitz, Kaname Takizawa, Pierre Bordachar, Kazumasa Adachi, F. Javier García-Fernández, Rodolfo Ventura, Sebastian Maier, Morio Shoda, Werner Jung |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Management of heart failure Cardiac resynchronization therapy Context (language use) 030204 cardiovascular system & hematology Cardiography Impedance Sensitivity and Specificity Cardiac Resynchronization Therapy 03 medical and health sciences QRS complex 0302 clinical medicine Internal medicine Electric Impedance medicine Humans Decompensation Prospective Studies 030212 general & internal medicine Aged Heart Failure Ejection fraction business.industry Stroke Volume medicine.disease Defibrillators Implantable Heart failure Cardiology Female Implant Cardiology and Cardiovascular Medicine business Algorithms |
| Zdroj: | Journal of Electrocardiology. 53:100-108 |
| ISSN: | 0022-0736 |
| Popis: | Aims Remote monitoring by implantable devices substantially improves management of heart failure (HF) patients by providing diagnostic day-to-day data. The use of thoracic impedance (TI) as a surrogate measure of fluid accumulation is still strongly debated. The multicenter HomeCARE-II study evaluated clinically apparent HF events in the context of remote device diagnostics, focusing on the controversial role of TI. Methods and results We followed 497 patients (66.6 ± 10.1 years, 77% male, QRS 139.8 ± 36.0 ms, ejection fraction 26.8 ± 7.0%) implanted with a CRT-D (67%) or an ICD (33%) for 21.4 ± 8.1 months. An independent event committee confirmed 171 HF events of which 82 were used to develop a TI-based algorithm for the prediction of imminent cardiac decompensation. Highly inter-individual variations in patterns of TI trends were observed. The algorithm resulted in a sensitivity of 41.5% (50.0%) with 0.95 (1.34) false alerts per patient year, and a positive predictive value of 7.9% overall and 27.9% in the HF event group of patients. Averaged ratio statistics showed a significant pre-hospital decrease and a highly significant in-hospital increase in TI after intensified diuresis. Recurrent decompensations turned out to be preceded by a significantly stronger decrease of TI compared to first events with a higher chance for detection (63.6% sensitivity, p Conclusions Overall performance in predicting imminent decompensation by monitoring TI alone is limited due to its high inter-patient variability. TI stand-alone applications should be redirected towards a target population with more advanced symptoms where post-hospital observation aimed to maintain the patient's discharge status might be the most valuable approach. Clinical trial registration ClinicalTrials.gov Identifier NCT00711360 (HomeCARE-II) and NCT01221649 (J-HomeCARE-II). |
| Databáze: | OpenAIRE |
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