An improved algorithm calculated from intrathoracic impedance can precisely diagnose preclinical heart failure events: Sub-analysis of a multicenter MOMOTARO (Monitoring and Management of OptiVol Alert to Reduce Heart Failure Hospitalization) trial study

Akihito Miyoshi, Nobuhiro Nishii, Motoki Kubo, Yoji Okamoto, Satoki Fujii, Atsuyuki Watanabe, Keisuke Okawa, Kenji Kawamoto, Hiroshi Morita, Hiroshi Ito

Research output: Contribution to journalArticle

Abstract

Background: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device has potential to assess fluid accumulation in patients with heart failure (HF), but it has failed to reduce HF-related hospitalization because of a high false-positive rate. Objective: We aimed to examine whether a modified algorithm (OptiVol 2.0) could reduce false-positive HF events documented in our multicenter trial (MOMOTARO). Methods: The MOMOTARO trial assessed the potential that fluid index could predict fluid accumulation and therefore HF. The MOMOTARO trial assessed whether HF events could be detected based on fluid accumulation as assessed by fluid index. We re-analyzed raw data of ITI trends of the threshold-crossing events with the modified algorithm. Results: The study consisted of 195 patients who had been implanted with a high-energy device. During a mean follow-up period of 658. ±. 165 days, there were 154 primary HF events detected by the previous algorithm (OptiVol 1.0). With the previous algorithm, there was no significant difference in log concentration of brain natriuretic peptide (BNP) between baseline and alert (p = 0.21). Among 150 alerts of the previous algorithm, only 37 reached the threshold by the modified algorithm, and log BNP was significantly higher in these 37 events compared with the baseline value (2.40. ±. 0.46 vs. 2.27. ±. 0.52, p <. 0.01). Conclusion: Our simulation study demonstrates that fluid index calculated with the modified algorithm reduces the number of false-positive threshold-crossing HF events and is promising for accurate diagnosis of fluid accumulation in patients.

Original languageEnglish
JournalJournal of Cardiology
DOIs
Publication statusAccepted/In press - 2017

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Electric Impedance
Hospitalization
Heart Failure
Brain Natriuretic Peptide
Equipment and Supplies
Multicenter Studies

Keywords

  • Brain natriuretic peptide
  • False-positive
  • Heart failure
  • Intrathoracic impedance
  • OptiVol alert

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{6b2d29e77cb14815aa4396978a32160b,
title = "An improved algorithm calculated from intrathoracic impedance can precisely diagnose preclinical heart failure events: Sub-analysis of a multicenter MOMOTARO (Monitoring and Management of OptiVol Alert to Reduce Heart Failure Hospitalization) trial study",
abstract = "Background: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device has potential to assess fluid accumulation in patients with heart failure (HF), but it has failed to reduce HF-related hospitalization because of a high false-positive rate. Objective: We aimed to examine whether a modified algorithm (OptiVol 2.0) could reduce false-positive HF events documented in our multicenter trial (MOMOTARO). Methods: The MOMOTARO trial assessed the potential that fluid index could predict fluid accumulation and therefore HF. The MOMOTARO trial assessed whether HF events could be detected based on fluid accumulation as assessed by fluid index. We re-analyzed raw data of ITI trends of the threshold-crossing events with the modified algorithm. Results: The study consisted of 195 patients who had been implanted with a high-energy device. During a mean follow-up period of 658. ±. 165 days, there were 154 primary HF events detected by the previous algorithm (OptiVol 1.0). With the previous algorithm, there was no significant difference in log concentration of brain natriuretic peptide (BNP) between baseline and alert (p = 0.21). Among 150 alerts of the previous algorithm, only 37 reached the threshold by the modified algorithm, and log BNP was significantly higher in these 37 events compared with the baseline value (2.40. ±. 0.46 vs. 2.27. ±. 0.52, p <. 0.01). Conclusion: Our simulation study demonstrates that fluid index calculated with the modified algorithm reduces the number of false-positive threshold-crossing HF events and is promising for accurate diagnosis of fluid accumulation in patients.",
keywords = "Brain natriuretic peptide, False-positive, Heart failure, Intrathoracic impedance, OptiVol alert",
author = "Akihito Miyoshi and Nobuhiro Nishii and Motoki Kubo and Yoji Okamoto and Satoki Fujii and Atsuyuki Watanabe and Keisuke Okawa and Kenji Kawamoto and Hiroshi Morita and Hiroshi Ito",
year = "2017",
doi = "10.1016/j.jjcc.2017.05.004",
language = "English",
journal = "Journal of cardiography. Supplement",
issn = "0914-5087",
publisher = "Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)",

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TY - JOUR

T1 - An improved algorithm calculated from intrathoracic impedance can precisely diagnose preclinical heart failure events

T2 - Sub-analysis of a multicenter MOMOTARO (Monitoring and Management of OptiVol Alert to Reduce Heart Failure Hospitalization) trial study

AU - Miyoshi, Akihito

AU - Nishii, Nobuhiro

AU - Kubo, Motoki

AU - Okamoto, Yoji

AU - Fujii, Satoki

AU - Watanabe, Atsuyuki

AU - Okawa, Keisuke

AU - Kawamoto, Kenji

AU - Morita, Hiroshi

AU - Ito, Hiroshi

PY - 2017

Y1 - 2017

N2 - Background: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device has potential to assess fluid accumulation in patients with heart failure (HF), but it has failed to reduce HF-related hospitalization because of a high false-positive rate. Objective: We aimed to examine whether a modified algorithm (OptiVol 2.0) could reduce false-positive HF events documented in our multicenter trial (MOMOTARO). Methods: The MOMOTARO trial assessed the potential that fluid index could predict fluid accumulation and therefore HF. The MOMOTARO trial assessed whether HF events could be detected based on fluid accumulation as assessed by fluid index. We re-analyzed raw data of ITI trends of the threshold-crossing events with the modified algorithm. Results: The study consisted of 195 patients who had been implanted with a high-energy device. During a mean follow-up period of 658. ±. 165 days, there were 154 primary HF events detected by the previous algorithm (OptiVol 1.0). With the previous algorithm, there was no significant difference in log concentration of brain natriuretic peptide (BNP) between baseline and alert (p = 0.21). Among 150 alerts of the previous algorithm, only 37 reached the threshold by the modified algorithm, and log BNP was significantly higher in these 37 events compared with the baseline value (2.40. ±. 0.46 vs. 2.27. ±. 0.52, p <. 0.01). Conclusion: Our simulation study demonstrates that fluid index calculated with the modified algorithm reduces the number of false-positive threshold-crossing HF events and is promising for accurate diagnosis of fluid accumulation in patients.

AB - Background: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device has potential to assess fluid accumulation in patients with heart failure (HF), but it has failed to reduce HF-related hospitalization because of a high false-positive rate. Objective: We aimed to examine whether a modified algorithm (OptiVol 2.0) could reduce false-positive HF events documented in our multicenter trial (MOMOTARO). Methods: The MOMOTARO trial assessed the potential that fluid index could predict fluid accumulation and therefore HF. The MOMOTARO trial assessed whether HF events could be detected based on fluid accumulation as assessed by fluid index. We re-analyzed raw data of ITI trends of the threshold-crossing events with the modified algorithm. Results: The study consisted of 195 patients who had been implanted with a high-energy device. During a mean follow-up period of 658. ±. 165 days, there were 154 primary HF events detected by the previous algorithm (OptiVol 1.0). With the previous algorithm, there was no significant difference in log concentration of brain natriuretic peptide (BNP) between baseline and alert (p = 0.21). Among 150 alerts of the previous algorithm, only 37 reached the threshold by the modified algorithm, and log BNP was significantly higher in these 37 events compared with the baseline value (2.40. ±. 0.46 vs. 2.27. ±. 0.52, p <. 0.01). Conclusion: Our simulation study demonstrates that fluid index calculated with the modified algorithm reduces the number of false-positive threshold-crossing HF events and is promising for accurate diagnosis of fluid accumulation in patients.

KW - Brain natriuretic peptide

KW - False-positive

KW - Heart failure

KW - Intrathoracic impedance

KW - OptiVol alert

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U2 - 10.1016/j.jjcc.2017.05.004

DO - 10.1016/j.jjcc.2017.05.004

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