Abstract
Background: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device may detect increases in pulmonary fluid retention early, but the clinical utility of this method is not well established. The goal of this study was to test whether conventional ITI-derived parameters can diagnose fluid retention that may cause early stage heart failure (HF). Methods and Results: HF patients implanted with high-energy devices with OptiVol (Medtronic) monitoring were enrolled in this study. Patients were monitored remotely. At both baseline and OptiVol alert, patients were assessed on standard examinations, including analysis of serum brain natriuretic peptide (BNP). From April 2010 to August 2011, 195 patients from 12 institutes were enrolled. There were 154 primary OptiVol alert events. BNP level at the alerts was not significantly different from that at baseline. Given that ITI was inversely correlated with log BNP, we added a criterion specifying that the OptiVol alert is triggered only when ITI decreases by ≥4% from baseline. This change improved the diagnostic potential of increase in BNP at OptiVol alert (sensitivity, 75%; specificity, 88%). Conclusions: BNP increase could not be identified based on OptiVol alert. Decrease in ITI ≥4% compared with baseline, in addition to the alert, however, may be a useful marker for the likelihood of HF (Clinical trial info: UMIN000003351).
| Original language | English |
|---|---|
| Pages (from-to) | 1315-1322 |
| Number of pages | 8 |
| Journal | Circulation Journal |
| Volume | 79 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - May 11 2015 |
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Keywords
- Brain natriuretic peptide
- Heart failure
- Intrathoracic impedance
- OptiVol alert
- Remote monitoring
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
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Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Decreased intrathoracic impedance associated with OptiVol alert can diagnose increased B-type natriuretic peptide – MOMOTARO (monitoring and management of OptiVol alert to reduce heart failure hospitalization) study –
AU - MOMOTARO
AU - Nishii, Nobuhiro
AU - Kubo, Motoki
AU - Okamoto, Yoji
AU - Fujii, Satoki
AU - Watanabe, Atsuyuki
AU - Toyama, Yuko
AU - Yamada, Tadakatsu
AU - Doi, Masayuki
AU - Morita, Hiroshi
AU - Itoh, Hiroshi
PY - 2015/5/11
Y1 - 2015/5/11
N2 - Background: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device may detect increases in pulmonary fluid retention early, but the clinical utility of this method is not well established. The goal of this study was to test whether conventional ITI-derived parameters can diagnose fluid retention that may cause early stage heart failure (HF). Methods and Results: HF patients implanted with high-energy devices with OptiVol (Medtronic) monitoring were enrolled in this study. Patients were monitored remotely. At both baseline and OptiVol alert, patients were assessed on standard examinations, including analysis of serum brain natriuretic peptide (BNP). From April 2010 to August 2011, 195 patients from 12 institutes were enrolled. There were 154 primary OptiVol alert events. BNP level at the alerts was not significantly different from that at baseline. Given that ITI was inversely correlated with log BNP, we added a criterion specifying that the OptiVol alert is triggered only when ITI decreases by ≥4% from baseline. This change improved the diagnostic potential of increase in BNP at OptiVol alert (sensitivity, 75%; specificity, 88%). Conclusions: BNP increase could not be identified based on OptiVol alert. Decrease in ITI ≥4% compared with baseline, in addition to the alert, however, may be a useful marker for the likelihood of HF (Clinical trial info: UMIN000003351).
AB - Background: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device may detect increases in pulmonary fluid retention early, but the clinical utility of this method is not well established. The goal of this study was to test whether conventional ITI-derived parameters can diagnose fluid retention that may cause early stage heart failure (HF). Methods and Results: HF patients implanted with high-energy devices with OptiVol (Medtronic) monitoring were enrolled in this study. Patients were monitored remotely. At both baseline and OptiVol alert, patients were assessed on standard examinations, including analysis of serum brain natriuretic peptide (BNP). From April 2010 to August 2011, 195 patients from 12 institutes were enrolled. There were 154 primary OptiVol alert events. BNP level at the alerts was not significantly different from that at baseline. Given that ITI was inversely correlated with log BNP, we added a criterion specifying that the OptiVol alert is triggered only when ITI decreases by ≥4% from baseline. This change improved the diagnostic potential of increase in BNP at OptiVol alert (sensitivity, 75%; specificity, 88%). Conclusions: BNP increase could not be identified based on OptiVol alert. Decrease in ITI ≥4% compared with baseline, in addition to the alert, however, may be a useful marker for the likelihood of HF (Clinical trial info: UMIN000003351).
KW - Brain natriuretic peptide
KW - Heart failure
KW - Intrathoracic impedance
KW - OptiVol alert
KW - Remote monitoring
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U2 - 10.1253/circj.CJ-15-0076
DO - 10.1253/circj.CJ-15-0076
M3 - Article
VL - 79
SP - 1315
EP - 1322
JO - Circulation Journal
JF - Circulation Journal
SN - 1346-9843
IS - 6
ER -