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SHIYOUDA Morio
Department School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine Position Endowed Professor |
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| Article types | Original article |
| Language | English |
| Peer review | Peer reviewed |
| Title | Evaluation of thoracic impedance trends for implant-based remote monitoring in heart failure patients - Results from the (J-)HomeCARE-II Study. |
| Journal | Formal name：Journal of electrocardiology Abbreviation：J Electrocardiol ISSN code：0022-0736/1532-8430 |
| Domestic / Foregin | Foregin |
| Publisher | Elsevier Inc. |
| Volume, Issue, Page | 53,pp.100-108 |
| Author and coauthor | 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 |
| Authorship | Last author |
| Publication date | 2019/03 |
| Summary | 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 |