aSacro Cuore Don Calabria, Negrar bMater Salutis, Legnago Verona cS. Maurizio, Bolzano dSanta Maria della Misericordia, Udine eAzienda Ospedaliera di Padova, Padova fBorgo Trento, Verona gAOU 'Policlinico-Vittorio Emanuele' Ferrarotto, Catania hS. Maria del Carmine, Rovereto iMedtronic Italia, Sesto San Giovanni. jSan Filippo Neri, Roma, Italy.
J Cardiovasc Med (Hagerstown). 2014 Apr;15(4):307-14. doi: 10.2459/JCM.0b013e328364bf50.
Heart failure has a relevant healthcare impact. Monitoring of pulmonary fluid overload (PFO), measured by intrathoracic impedance, has been proposed to alert to heart failure worsening before symptoms become patent. The aim of our research was to evaluate whether PFO diagnostics reduce heart failure hospitalizations in heart failure patients receiving single-chamber or dual-chamber implantable cardioverter-defibrillator (ICD) for primary prevention of sudden death.
Twenty-five Italian cardiological centers prospectively followed 221 ICD patients (86% men, 66 ± 11 years, 79% New York Heart Association II and left ventricular ejection fraction 28 ± 5%), of whom 123 received an ICD with PFO monitoring (diagnostics group) and 98 an ICD without such a diagnostics (control group). The association of each patient to a group was assigned a priori, independently of patients' characteristics but based on regional device allocation policies.
Patient clinical characteristics and observation period were similar between groups. In a mean follow-up of 17 ± 11 months, heart failure hospitalizations or emergency-room admissions occurred in eight (7%) patients of the diagnostics group and in 16 of the control group (16%; P = 0.02), with an incidence, measured by Kaplan-Meier analysis, of 23% at 2 years and 34% at 3 years in patients of the control group compared with 8% at 2 and 3 years in patients of the diagnostics group (Log rank test P = 0.044).
Our data show that in heart failure patients receiving single-chamber or dual-chamber ICD, the use of intrathoracic impedance monitoring is associated with a significant reduction of heart failure hospitalizations. Our results support the hypothesis that PFO diagnostics improve the likelihood of timely detection of heart failure worsening.
心力衰竭对医疗保健有重要影响。据报道，通过胸腔内阻抗监测肺液超负荷（PFO）可以在心力衰竭症状出现之前提示心力衰竭恶化。本研究旨在评估 PFO 诊断是否可以减少因原发性预防猝死而接受单腔或双腔植入式心脏复律除颤器（ICD）治疗的心力衰竭患者的心力衰竭住院率。
25 家意大利心脏病学中心前瞻性随访了 221 例 ICD 患者（86%为男性，66±11 岁，79%为纽约心脏协会 II 级，左心室射血分数 28±5%），其中 123 例患者接受了具有 PFO 监测功能的 ICD（诊断组），98 例患者接受了不具有该功能的 ICD（对照组）。患者分组是根据区域设备分配政策预先设定的，分组与患者特征无关，而是基于预先设定的分组规则。
两组患者的临床特征和观察期相似。在平均 17±11 个月的随访期间，诊断组有 8 例（7%）患者和对照组有 16 例（16%）患者发生心力衰竭住院或急诊就诊（P=0.02），Kaplan-Meier 分析显示，对照组患者的 2 年和 3 年累积发病率分别为 23%和 34%，而诊断组患者的相应发病率分别为 8%和 13%（对数秩检验 P=0.044）。
我们的数据表明，在接受单腔或双腔 ICD 的心力衰竭患者中，使用胸腔内阻抗监测可显著降低心力衰竭住院率。我们的结果支持这样一种假设，即 PFO 诊断可提高及时发现心力衰竭恶化的可能性。
