Vollmann Dirk, Nägele Herbert, Schauerte Patrick, Wiegand Uwe, Butter Christian, Zanotto Gabriele, Quesada Aurelio, Guthmann Axel, Hill Michael R S, Lamp Barbara
Herzzentrum, Abteilung Kardiologie und Pneumologie, Klinikum der Georg-August-Universität, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
Eur Heart J. 2007 Aug;28(15):1835-40. doi: 10.1093/eurheartj/ehl506. Epub 2007 Feb 19.
To evaluate the utility of intrathoracic impedance monitoring for detecting heart failure (HF) deterioration in patients with an implanted cardiac resynchronization/defibrillation device.
Patients enrolled in the European InSync Sentry Observational Study were audibly alerted by a device algorithm if a decrease in intrathoracic impedance suggested fluid accumulation. Clinical HF status and device data were assessed at enrolment, during regular follow-up, and if patients presented with an alert or HF deterioration. Data from 373 subjects were analysed. Fifty-three alert events and a total of 53 clinical events (HF deterioration defined by worsening of HF signs and symptoms) were reported during a median of 4.2 months. Adjusted for multiple events per patient, the alert detected clinical HF deterioration with 60% sensitivity (95% CI 46-73) and with a positive predictive value of 60% (95% CI 46-73). Higher NYHA class at baseline was predictive for adequate alert events during follow-up (P < 0.05). In 11 of 20 HF deteriorations without preceding alert, an upstroke of the fluid index occurred without reaching the programmed alert threshold.
A device-based algorithm that alerts patients in case of decreasing intrathoracic impedance facilitates the detection of HF deterioration. Future randomized, controlled trials are needed to test whether the tailored use of intrathoracic impedance monitoring can improve the ambulatory management of patients with chronic HF and an implanted device.
评估植入式心脏再同步化/除颤装置患者胸腔内阻抗监测对检测心力衰竭（HF）恶化的效用。
欧洲InSync Sentry观察性研究纳入的患者，如果胸腔内阻抗降低提示液体蓄积，装置算法会发出听觉警报。在入组时、定期随访期间以及患者出现警报或HF恶化时评估临床HF状态和装置数据。分析了373名受试者的数据。在中位4.2个月期间，报告了53次警报事件和总共53次临床事件（HF恶化定义为HF体征和症状恶化）。对每位患者的多次事件进行校正后，警报检测临床HF恶化的敏感性为60%（95%CI 46 - 73），阳性预测值为60%（95%CI 46 - 73）。基线时较高的纽约心脏协会（NYHA）分级可预测随访期间出现足够的警报事件（P < 0.05）。在20次无先前警报的HF恶化中，有11次液体指数上升但未达到设定的警报阈值。
一种在胸腔内阻抗降低时向患者发出警报的基于装置的算法有助于检测HF恶化。需要未来的随机对照试验来测试胸腔内阻抗监测的针对性使用是否能改善慢性HF植入装置患者的门诊管理。
