Key result
Adding a ~4% intrathoracic impedance drop to OptiVol alerts improves BNP detection accuracy over alerts alone.
Why the study?
The clinical utility of ambulatory intrathoracic impedance measurement with implanted devices to detect early pulmonary fluid retention in heart failure patients is not well established.
Does adding a criterion of ≥4% decrease in intrathoracic impedance to OptiVol alerts improve the diagnosis of increased BNP in heart failure patients implanted with high-energy devices?
Observational (n=195)
Yes
Does adding a criterion of ≥4% decrease in intrathoracic impedance to OptiVol alerts improve the diagnosis of increased BNP in heart failure patients implanted with high-energy devices?
Requiring a ≥4% decrease in intrathoracic impedance alongside OptiVol alerts significantly improves the diagnostic accuracy for detecting elevated BNP and early fluid retention in heart failure patients.
OptiVol alerts alone should not trigger HF intervention; supports refining ITI thresholds in prospective trials before clinical adoption.
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).
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Nishii et al. (2015) conducted an observational in Heart failure (n=195). OptiVol alert vs. Baseline was evaluated on Log serum brain natriuretic peptide (BNP) (p=0.21). OptiVol alerts alone did not significantly identify increases in brain natriuretic peptide (log BNP 2.24 vs 2.21, P=0.21), but requiring a concurrent ≥4% decrease in intrathoracic impedance improved diagnostic accuracy.
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