シヨウダ　モリオ   SHODA Morio   庄田　守男    所属   医学部 医学科（東京女子医科大学病院）    職種   寄附部門教授
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Evaluation of thoracic impedance trends for implant-based remote monitoring in heart failure patients - Results from the (J-)HomeCARE-II Study.
掲載誌名	正式名：Journal of electrocardiology 略　 称：J Electrocardiol ISSNコード：0022-0736/1532-8430
掲載区分	国外
出版社	Elsevier Inc.
巻・号・頁	53,pp.100-108
著者・共著者	Maier Sebastian K G, Paule Stefan, Jung Werner, Koller Marcus, Ventura Rodolfo, Quesada Aurelio, Bordachar Pierre, García-Fernández F Javier, Schumacher Burghard, Lobitz Nicole, Takizawa Kaname, Ando Kenji, Adachi Kazumasa, Shoda Morio
担当区分	最終著者
発行年月	2019/03
概要	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 b 0.05). 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 (JHomeCARE-II).
DOI	10.1016/j.jelectrocard.2019.01.004
PMID	30739055