Department of Medicine, Jefferson Medical College, 925 Chestnut Street, Philadelphia, PA 19107, USA.
J Am Coll Cardiol. 2010 Apr 27;55(17):1803-10. doi: 10.1016/j.jacc.2009.11.089.
We sought to determine the utility of combined heart failure (HF) device diagnostic information to predict clinical deterioration of HF in patients with systolic left ventricular dysfunction.
Some implantable devices continuously monitor HF device diagnostic information, but data are limited on the ability of combined HF device diagnostics to predict HF events.
The PARTNERS HF (Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure) was a prospective, multicenter observational study in patients receiving cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillators. HF events were independently adjudicated. A combined HF device diagnostic algorithm was developed on an independent dataset. The algorithm was considered positive if a patient had 2 of the following abnormal criteria during a 1-month period: long atrial fibrillation duration, rapid ventricular rate during atrial fibrillation, high (> or =60) fluid index, low patient activity, abnormal autonomics (high night heart rate or low heart rate variability), or notable device therapy (low CRT pacing or implantable cardioverter-defibrillator shocks), or if they only had a very high (> or =100) fluid index. We used univariate and multivariable analyses to determine predictors of subsequent HF events within a month.
We analyzed data from 694 CRT defibrillator patients who were followed for 11.7 +/- 2 months. Ninety patients had 141 adjudicated HF hospitalizations with pulmonary congestion at least 60 days after implantation. Patients with a positive combined HF device diagnostics had a 5.5-fold increased risk of HF hospitalization with pulmonary signs or symptoms within the next month (hazard ratio: 5.5, 95% confidence interval: 3.4 to 8.8, p < 0.0001), and the risk remained high after adjusting for clinical variables (hazard ratio: 4.8, 95% confidence interval: 2.9 to 8.1, p < 0.0001).
Monthly review of HF device diagnostic data identifies patients at a higher risk of HF hospitalizations within the subsequent month. (PARTNERS HF: Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure; NCT00279955).
我们旨在确定心力衰竭（HF）综合设备诊断信息在预测左心室收缩功能障碍患者心力衰竭临床恶化方面的效用。
一些植入式设备可连续监测 HF 设备诊断信息，但有关综合 HF 设备诊断结果预测 HF 事件能力的数据有限。
PARTNERS HF（心力衰竭患者获取和回顾趋势信息及评估症状相关性计划）是一项接受心脏再同步治疗（CRT）植入式心脏复律除颤器的患者的前瞻性、多中心观察性研究。HF 事件由独立的评估人员进行裁定。在独立数据集上开发了一种综合 HF 设备诊断算法。如果患者在 1 个月期间有以下 2 种异常标准中的 2 种，则认为该算法为阳性：长心房颤动持续时间、心房颤动期间快速心室率、高（≥60）液体指数、低患者活动、异常自主神经（高夜间心率或低心率变异性）或显著设备治疗（低 CRT 起搏或植入式心脏复律除颤器电击），或者只有非常高（≥100）液体指数。我们使用单变量和多变量分析来确定一个月内后续 HF 事件的预测因素。
我们分析了 694 例 CRT 除颤器患者的数据，这些患者的随访时间为 11.7 ± 2 个月。90 例患者出现了 141 例经裁定的 HF 住院治疗事件，这些事件均在植入后至少 60 天出现肺充血。HF 综合设备诊断阳性的患者在接下来的一个月内发生 HF 住院治疗且伴有肺部充血体征或症状的风险增加了 5.5 倍（风险比：5.5，95%置信区间：3.4 至 8.8，p<0.0001），且在调整临床变量后风险仍然较高（风险比：4.8，95%置信区间：2.9 至 8.1，p<0.0001）。
每月回顾 HF 设备诊断数据可识别出随后 1 个月内 HF 住院治疗风险较高的患者。（PARTNERS HF：Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure；NCT00279955）。
