Akihito Miyoshi1, Nobuhiro Nishii2, Motoki Kubo1, Yoji Okamoto3, Satoki Fujii3, Atsuyuki Watanabe4, Keisuke Okawa5, Kenji Kawamoto6, Hiroshi Morita7, Hiroshi Ito1. 1. Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. 2. Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. Electronic address: nnishii@md.okayama-u.ac.jp. 3. Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan. 4. Department of Cardiovascular Medicine, Fukuyama City Hospital, Fukuyama, Japan. 5. Department of Cardiovascular Medicine, Kagawa Prefectural Central Hospital, Takamatsu, Japan. 6. Department of Cardiovascular Medicine, Iwakuni Medical Center, Iwakuni, Japan. 7. Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Abstract
BACKGROUND: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device has potential to assess fluid accumulation in patients with heart failure (HF), but it has failed to reduce HF-related hospitalization because of a high false-positive rate. OBJECTIVE: We aimed to examine whether a modified algorithm (OptiVol 2.0) could reduce false-positive HF events documented in our multicenter trial (MOMOTARO). METHODS: The MOMOTARO trial assessed the potential that fluid index could predict fluid accumulation and therefore HF. The MOMOTARO trial assessed whether HF events could be detected based on fluid accumulation as assessed by fluid index. We re-analyzed raw data of ITI trends of the threshold-crossing events with the modified algorithm. RESULTS: The study consisted of 195 patients who had been implanted with a high-energy device. During a mean follow-up period of 658±165 days, there were 154 primary HF events detected by the previous algorithm (OptiVol 1.0). With the previous algorithm, there was no significant difference in log concentration of brain natriuretic peptide (BNP) between baseline and alert (p=0.21). Among 150 alerts of the previous algorithm, only 37 reached the threshold by the modified algorithm, and log BNP was significantly higher in these 37 events compared with the baseline value (2.40±0.46 vs. 2.27±0.52, p<0.01). CONCLUSION: Our simulation study demonstrates that fluid index calculated with the modified algorithm reduces the number of false-positive threshold-crossing HF events and is promising for accurate diagnosis of fluid accumulation in patients.
BACKGROUND: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device has potential to assess fluid accumulation in patients with heart failure (HF), but it has failed to reduce HF-related hospitalization because of a high false-positive rate. OBJECTIVE: We aimed to examine whether a modified algorithm (OptiVol 2.0) could reduce false-positive HF events documented in our multicenter trial (MOMOTARO). METHODS: The MOMOTARO trial assessed the potential that fluid index could predict fluid accumulation and therefore HF. The MOMOTARO trial assessed whether HF events could be detected based on fluid accumulation as assessed by fluid index. We re-analyzed raw data of ITI trends of the threshold-crossing events with the modified algorithm. RESULTS: The study consisted of 195 patients who had been implanted with a high-energy device. During a mean follow-up period of 658±165 days, there were 154 primary HF events detected by the previous algorithm (OptiVol 1.0). With the previous algorithm, there was no significant difference in log concentration of brain natriuretic peptide (BNP) between baseline and alert (p=0.21). Among 150 alerts of the previous algorithm, only 37 reached the threshold by the modified algorithm, and log BNP was significantly higher in these 37 events compared with the baseline value (2.40±0.46 vs. 2.27±0.52, p<0.01). CONCLUSION: Our simulation study demonstrates that fluid index calculated with the modified algorithm reduces the number of false-positive threshold-crossing HF events and is promising for accurate diagnosis of fluid accumulation in patients.
Authors: Andrea Coravos; Jennifer C Goldsack; Daniel R Karlin; Camille Nebeker; Eric Perakslis; Noah Zimmerman; M Kelley Erb Journal: Digit Biomark Date: 2019-05-09
Authors: Hye Bin Gwag; June Soo Kim; Kyoung-Min Park; Young Keun On; Seung-Jung Park Journal: J Interv Card Electrophysiol Date: 2021-03-27 Impact factor: 1.900