Small Roy S
Heart Failure Clinic, The Heart Group, Lancaster, Pennsylvania 17603, USA.
Am J Cardiol. 2007 May 21;99(10A):17G-22G. doi: 10.1016/j.amjcard.2007.02.038. Epub 2007 Mar 9.
Heart failure is a difficult and costly disease to manage in part because the symptoms may be protean, the physical findings obscure, and the laboratory assessments unreliable. New implanted physiologic monitors may simplify the care of patients with heart failure, if they can be incorporated into routine clinical practice. Cardiac resynchronization therapy/defibrillators and implantable cardioverter defibrillators with continuous intrathoracic impedance monitoring capabilities (OptiVol fluid status monitoring; Medtronic, Inc., Minneapolis, MN) have recently been introduced and may provide an early warning of thoracic fluid retention. However, patients who have devices with this diagnostic capability must be identified, and the device-based information must be accessed systematically, if it is to be used in the disease management process. Ancillary information, such as the Heart Failure Management Report that is generated from data stored in Medtronic devices, may facilitate recognition of disease mechanisms associated with decompensation. The predictive value of continuous intrathoracic impedance monitoring with an implantable device is still unknown. Thus, therapeutic decisions should be made in conjunction with a clinical assessment. Physicians and other healthcare providers will need to become familiar with these devices so they can appreciate their advantages and limitations.
心力衰竭是一种管理起来既困难又昂贵的疾病，部分原因在于其症状可能多种多样，体格检查结果不明确，实验室评估也不可靠。如果新型植入式生理监测器能够融入常规临床实践，那么它们可能会简化心力衰竭患者的护理工作。具有连续胸腔内阻抗监测功能的心脏再同步治疗/除颤器和植入式心脏复律除颤器（OptiVol液体状态监测；美敦力公司，明尼阿波利斯，明尼苏达州）最近已被推出，可能会对胸腔积液潴留提供早期预警。然而，如果要将基于设备的信息用于疾病管理过程，就必须识别出具有这种诊断能力的患者，并系统地获取这些信息。辅助信息，如从美敦力设备存储的数据中生成的心力衰竭管理报告，可能有助于识别与失代偿相关的疾病机制。植入式设备进行连续胸腔内阻抗监测的预测价值仍然未知。因此，治疗决策应结合临床评估做出。医生和其他医疗服务提供者需要熟悉这些设备，以便了解它们的优缺点。
