Decreased Intrathoracic Impedance Associated With OptiVol Alert Can Diagnose Increased B-Type Natriuretic Peptide - MOMOTARO (Monitoring and Management of OptiVol Alert to Reduce Heart Failure Hospitalization) Study - .
Decreased Intrathoracic Impedance Associated With OptiVol Alert Can Diagnose Increased B-Type Natriuretic Peptide - MOMOTARO (Monitoring and Management of OptiVol Alert to Reduce Heart Failure Hospitalization) Study - .
复制标题
与 OptiVol Alert 相关的胸内阻抗降低可以诊断 B 型利尿钠肽增加 - MOMOTARO（OptiVol Alert 的监测和管理以减少心力衰竭住院率）研究 - 。
作者：
Nobuhiro Nishii;Motoki Kubo;Yoji Okamoto;S. Fujii;Atsuyuki Watanabe;Yuko Toyama;Tadakatsu Yamada;M. Doi;H. Morita;Hiroshi Ito
背景
使用植入装置进行胸内阻抗（ITI）的动态测量可早期检测肺液体潴留的增加，但该方法的临床实用性尚未得到充分证实。本研究的目的是测试传统的ITI衍生参数是否可以诊断可能导致早期心力衰竭（HF）的液体潴留。
方法和结果
本研究入组了植入高能量器械并进行Optimptum（Medtronic）监测的HF患者。患者被远程监控。在基线和Optionalert时，对患者进行标准检查评估，包括血清脑钠肽（BNP）分析。从2010年4月至2011年8月，来自12个研究机构的195例患者入组。有154起主要OptimalTM警报事件。警报时BNP水平与基线时无显著差异。鉴于ITI与log BNP呈负相关，我们增加了一项标准，规定仅当ITI较基线降低≥4%时才触发Optivalent警报。这一变化提高了Optionalert时BNP升高的诊断潜力（灵敏度，75%;特异性，88%）。
结论
根据Optivalent alert，无法识别BNP升高。然而，除了警报之外，ITI与基线相比降低≥4%可能是HF可能性的有用标志物（临床试验信息：UMIN 000003351）。
BACKGROUND
Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device may detect increases in pulmonary fluid retention early, but the clinical utility of this method is not well established. The goal of this study was to test whether conventional ITI-derived parameters can diagnose fluid retention that may cause early stage heart failure (HF).
METHODS AND RESULTS
HF patients implanted with high-energy devices with OptiVol (Medtronic) monitoring were enrolled in this study. Patients were monitored remotely. At both baseline and OptiVol alert, patients were assessed on standard examinations, including analysis of serum brain natriuretic peptide (BNP). From April 2010 to August 2011, 195 patients from 12 institutes were enrolled. There were 154 primary OptiVol alert events. BNP level at the alerts was not significantly different from that at baseline. Given that ITI was inversely correlated with log BNP, we added a criterion specifying that the OptiVol alert is triggered only when ITI decreases by ≥4% from baseline. This change improved the diagnostic potential of increase in BNP at OptiVol alert (sensitivity, 75%; specificity, 88%).
CONCLUSIONS
BNP increase could not be identified based on OptiVol alert. Decrease in ITI ≥4% compared with baseline, in addition to the alert, however, may be a useful marker for the likelihood of HF (Clinical trial info: UMIN000003351).
DOI：
10.1056/nejmoa1010029
发表时间：
2010-12-09
期刊：
The New England journal of medicine
影响因子：
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作者：
Chaudhry SI;Mattera JA;Curtis JP;Spertus JA;Herrin J;Lin Z;Phillips CO;Hodshon BV;Cooper LS;Krumholz HM
通讯作者：
Krumholz HM