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Leveraging cardiac resynchronization therapy devices to monitor patients with heart failure

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Abstract

Cardiac resynchronization therapy is a standard therapy for heart failure patients with cardiac dyssynchrony. The implantable device provides a convenient and continuous platform for heart failure monitoring. Information such as heart rate variability and activity status retrieved from the device allows physicians to more comprehensively evaluate these high-risk patients. Several registries and prospective observational studies have evaluated the value of intrathoracic impedance monitoring in predicting exacerbation of heart failure. With its sensitivity and positive predictive power, the fluid index—derived from the raw intrathoracic impedance—may alert clinicians to subclinical or clinical heart failure deterioration. Uncertainty remains as to whether the additional device-derived information will translate into clinical benefit by reducing the number of hospitalizations for heart failure. An ongoing randomized controlled clinical trial is expected to clarify the role of the device-based pulmonary fluid index in the management of heart failure.

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References and Recommended Reading

  1. Jessup M, Brozena S: Heart failure. N Engl J Med 2003, 348:2007–2018.

    Article  PubMed  Google Scholar 

  2. Hunt SA, Abraham WT, Chin MH, et al.: ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005, 112:e154–e235.

    Article  PubMed  Google Scholar 

  3. Yu CM, Chau E, Sanderson JE, et al.: Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002, 105:438–445.

    Article  PubMed  Google Scholar 

  4. Fung JW, Chan JY, Yip GW, et al.: Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy. Heart 2007, 93:432–437.

    Article  PubMed  Google Scholar 

  5. Mortara A, La Rovere MT, Pinna GD, et al.: Nonselective beta-adrenergic blocking agent, carvedilol, improves arterial baroreflex gain and heart rate variability in patients with stable chronic heart failure. J Am Coll Cardiol 2000, 36:1612–1618.

    Article  PubMed  CAS  Google Scholar 

  6. Cohn JN, Johnson GR, Shabetai R, et al.: Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. Circulation 1993, 87(Suppl 6):V15–V16.

    Google Scholar 

  7. Fantoni C, Raffa S, Regoli F, et al.: Cardiac resynchronization therapy improves heart rate profile and heart rate variability of patients with moderate to severe heart failure. J Am Coll Cardiol 2005, 46:1875–1882.

    Article  PubMed  Google Scholar 

  8. Adamson PB, Smith AL, Abraham WT, et al.: Continuous autonomic assessment in patients with symptomatic heart failure: prognostic value of heart rate variability measured by an implanted cardiac resynchronization device. Circulation 2004, 110:2389–2394.

    Article  PubMed  Google Scholar 

  9. Nolan J, Batin PD, Andrews R, et al.: Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation 1998, 98:1510–1516.

    PubMed  CAS  Google Scholar 

  10. La Rovere MT, Pinna GD, Maestri R, et al.: Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation 2003, 107:565–570.

    Article  PubMed  Google Scholar 

  11. Adamson PB, Kleckner KJ, VanHout WL, et al.: Cardiac resynchronization therapy improves heart rate variability in patients with symptomatic heart failure. Circulation 2003, 108:266–269.

    Article  PubMed  Google Scholar 

  12. Carson PE, Johnson GR, Dunkman WB, et al.: The influence of atrial fibrillation on prognosis in mild to moderate heart failure. The V-HeFT Studies. The V-HeFT VA Cooperative Studies Group. Circulation 1993, 87(Suppl 6):VI102–VI110.

    PubMed  CAS  Google Scholar 

  13. Walsh JT, Charlesworth A, Andrews R, et al.: Relation of daily activity levels in patients with chronic heart failure to long-term prognosis. Am J Cardiol 1997, 79:1364–1369.

    Article  PubMed  CAS  Google Scholar 

  14. Braunschweig F, Mortensen PT, Gras D, et al.: Monitoring of physical activity and heart rate variability in patients with chronic heart failure using cardiac resynchronization devices. Am J Cardiol 2005, 95:1104–1107.

    Article  PubMed  Google Scholar 

  15. Wang L, Lahtinen S, Lentz L, et al.: Feasibility of using an implantable system to measure thoracic congestion in an ambulatory chronic heart failure canine model. Pacing Clin Electrophysiol 2005, 28:404–411.

    Article  PubMed  Google Scholar 

  16. Ramos MU, LaBree JW, Remole W, Kubicek WG: Transthoracic electric impedance. A clinical guide of pulmonary fluid accumulation in congestive heart failure. Minn Med 1975, 58:671–676.

    PubMed  CAS  Google Scholar 

  17. Yamamoto T, Yamamoto Y, Ozawa T: Characteristics of skin admittance for dry electrodes and the measurement of skin moisturisation. Med Biol Eng Comput 1986, 24:71–77.

    Article  PubMed  CAS  Google Scholar 

  18. Yu CM, Wang L, Chau E, et al.: Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 2005, 112:841–848.

    Article  PubMed  Google Scholar 

  19. Ypenburg C, Bax JJ, van der Wall EE, et al.: Intrathoracic impedance monitoring to predict decompensated heart failure. Am J Cardiol 2007, 99:554–557.

    Article  PubMed  Google Scholar 

  20. Maines M, Catanzariti D, Cemin C, et al.: Usefulness of intrathoracic fluids accumulation monitoring with an implantable biventricular defibrillator in reducing hospitalizations in patients with heart failure: a case-control study. J Interv Card Electrophysiol 2007, 19:201–207.

    Article  PubMed  Google Scholar 

  21. Vollmann D, Nagele H, Schauerte P, et al.: Clinical utility of intrathoracic impedance monitoring to alert patients with an implanted device of deteriorating chronic heart failure. Eur Heart J 2007, 28:1835–1840.

    Article  PubMed  Google Scholar 

  22. Stevenson LW, Perloff JK: The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA 1989, 261:884–888.

    Article  PubMed  CAS  Google Scholar 

  23. Luthje L, Vollmann D, Drescher T, et al.: Intrathoracic impedance monitoring to detect chronic heart failure deterioration: relationship to changes in NT-proBNP. Eur J Heart Fail 2007, 9:716–722.

    Article  PubMed  Google Scholar 

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Correspondence to Jeffrey Wing-Hong Fung.

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Fung, J.WH., Yu, CM. Leveraging cardiac resynchronization therapy devices to monitor patients with heart failure. Curr Heart Fail Rep 5, 44–50 (2008). https://doi.org/10.1007/s11897-008-0008-y

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