Key result
In an experimental ovine model of heart failure, natriuretic peptides responded rapidly to acute left atrial pressure changes, whereas intrathoracic impedance changes were delayed.
In an ovine model of heart failure, direct left atrial pressure, intrathoracic impedance, and natriuretic peptides all show promise as early indicators of worsening HF, though impedance changes are delayed relative to LAP and natriuretic peptides.
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Natriuretic peptides may enable faster HF detection than impedance; leaves open clinical translation from ovine models.
Monitoring of HF (heart failure) with intracardiac pressure, intrathoracic impedance and/or natriuretic peptide levels has been advocated. We aimed to investigate possible differences in the response patterns of each of these monitoring modalities during HF decompensation that may have an impact on the potential for early therapeutic intervention. Six sheep were implanted with a LAP (left atrial pressure) sensor and a CRT-D (cardiac resynchronization therapy defibrillator) capable of monitoring impedance along six lead configuration vectors. An estimate of ALAP (LAP from admittance) was determined by linear regression. HF was induced by rapid ventricular pacing at 180 and 220 bpm (beats/min) for a week each, followed by a third week with daily pacing suspensions for increasing durations (1-5 h). Incremental pacing induced progressively severe HF reflected in increases in LAP (5.9 ± 0.4 to 24.5 ± 1.6 mmHg) and plasma atrial (20 ± 3 to 197 ± 36 pmol/l) and B-type natriuretic peptide (3.7 ± 0.7 to 32.7 ± 5.4 pmol/l) (all P<0.001) levels. All impedance vectors decreased in proportion to HF severity (all P<0.001), with the LVring (left ventricular)-case vector correlating best with LAP (r2=0.63, P<0.001). Natriuretic peptides closely paralleled rapid acute changes in LAP during alterations in pacing (P<0.001), whereas impedance changes were delayed relative to LAP. ALAP exhibited good agreement with LAP. In summary, impedance measured with an LV lead correlates significantly with changes in LAP, but exhibits a delayed response to acute alterations. Natriuretic peptides respond rapidly to acute LAP changes. Direct LAP, impedance and natriuretic peptide measurements all show promise as early indicators of worsening HF. ALAP provides an estimate of LAP that may be clinically useful.
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Rademaker et al. (2010) studied Heart failure (n=6). Monitoring of left atrial pressure, intrathoracic impedance, and natriuretic peptides was evaluated on Response patterns of monitoring modalities during heart failure decompensation. In an experimental ovine model of heart failure, natriuretic peptides responded rapidly to acute left atrial pressure changes, whereas intrathoracic impedance changes were delayed.
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