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Implantable CRT device diagnostics identify patients with increased risk for heart failure hospitalization

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the association between device-determined diagnostic indices, including intrathoracic impedance, and heart failure (HF) hospitalization.

Methods

Clinical and device diagnostic data of 558 HF patients indicated for CRT-D therapy (In Sync Sentry, Medtronic Inc.) were prospectively collected from 34 centers. Device-recorded intrathoracic impedance fluid index threshold crossing event (TCE), mean activity counts, tachyarrhythmia events, night heart rate (NHR) and heart rate variability (HRV) were compared within patients with vs. without documented HF hospitalization.

Results

Mean follow-up was 326 ± 216 days. Patients hospitalized for HF had significantly higher rates of TCE, a higher percentage of days with the thoracic impedance fluid index above the programmed threshold, a higher percentage of days with low activity, with low HRV or with high NHR.

Multivariate analysis showed that TCE resulted in a 36% increased probability of HF hospitalization. Both TCE duration and patient activity were also significantly associated with hospitalization. Kaplan Meier analysis indicated that patients with more TCE events were significantly more likely to be hospitalized (log rank test, p = 0.005).

Conclusions

Decreased intrathoracic impedance, low patient activity and low HRV were all independently associated with increased risk for HF hospitalization in HF patients treated with resynchronization therapy. Device-derived diagnostic data may provide valuable and reliable indices for the prognostic stratification of HF patients.

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Acknowledgements

The authors would like to thank Clinical Service Team of Medtronic Italy for the Clinical Service project organization and management.

Disclosures

Annamaria Varbaro, Alessandra Denaro, S. Sarkar, D.A. Hettrick are employees of Medtronic, Inc.

Conflict of interest statement

No other conflict of interest exists.

Author information

Authors and Affiliations

  1. Istituto Auxologico S. Luca, Milan, Italy

    Giovanni B. Perego

  2. Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy

    Maurizio Landolina

  3. Ospedale Santa Maria del Carmine, Rovereto, Italy

    Giuseppe Vergara

  4. Ospedale Niguarda, Milan, Italy

    Maurizio Lunati

  5. Ospedale Civile Maggiore di Borgo Trento, Verona, Italy

    Gabriele Zanotto

  6. IRCCS S. Raffaele, Milan, Italy

    Alessia Pappone

  7. Ospedale Mater Salutis, Legnago, Italy

    Gabriele Lonardi

  8. Ospedale Civile G. Mazzini, Teramo, Italy

    Giancarlo Speca

  9. S. Anna Hospital, Catanzaro, Italy

    Saverio Iacopino

  10. Medtronic Italia, Rome, Italy

    Annamaria Varbaro & Alessandra Denaro

  11. Medtronic Inc., Minneapolis, MN, USA

    Shantanu Sarkar & Doug A. Hettrick

  12. Ospedale S. Luca, Via Spagnoletto 3, 20149, Milan, Italy

    Giovanni B. Perego

Authors
  1. Giovanni B. Perego
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  2. Maurizio Landolina
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  3. Giuseppe Vergara
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  4. Maurizio Lunati
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  5. Gabriele Zanotto
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  6. Alessia Pappone
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  7. Gabriele Lonardi
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  8. Giancarlo Speca
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  9. Saverio Iacopino
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  10. Annamaria Varbaro
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  11. Shantanu Sarkar
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  13. Alessandra Denaro
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Consortia

Optivol-CRT Clinical Service Observational Group

Corresponding author

Correspondence to Giovanni B. Perego.

Appendix

Appendix

1.1 List of participating centers and physicians

L. Tavazzi,, M. Landolina, R. Rordorf, Policlinico San Matteo—Pavia; M. Lunati, M. Frigerio, F. Oliva, Ospedale Niguarda Ca Granda—Milano; G. Vergara, M. Maines, Ospedale Santa Maria Del Carmine - Rovereto; C. Vassanelli, G. Zanotto, Ospedale Civile Maggiore di Borgo Trento –Verona; G. Lonardi, E. Visentin, Ospedale Mater Salutis di Legnago—Legnago; G. Perego, R. Brambilla, Ist. Auxologico Italiano-Ospedale S.Luca—Milano; M. Santini, R. Ricci, Ospedale San Filippo Neri—Roma; G. Speca, T. Agricola, Ospedale Civile G. Mazzini—Teramo; M.Cassese, S. Iacopino, S. Anna Hospital—Catanzaro; A. Proclemer, D. Facchin, Az. Ospedaliera S.Maria della Misericordia—Udine; P. Ravazzi, P. Diotallevi, Ospedale SS. Antonio e Biagio—Alessandria; R. Ometto, C. Bonanno, ULSS N.6 S. Bortolo—Vicenza; W. Rauhe, F. Pescoller, Ospedale Regionale San Maurizio—Bolzano; M. Gasparini, C. Ceriotti, F. Regoli, Instituto Clinico Humanitas—Rozzano (MI); M. Sassara, F. Turreni, Ospedale Belcolle—Viterbo; C. Pappone, G. Paglino, Ospedale San Raffaele—Milano; M. Bernasconi, G. Guenzati, Ospedale San Carlo Borromeo—Milano; L. Padeletti, P. Pieragnoli, Azienda Ospedaliera Careggi—Firenze; F.Gaita, M. Bocchiardo, M. Scaglione, Ospedale Civile—Asti; A. Curnis, L. Bontempi, Azienza Ospedaliera Spedali Civili—Brescia; G. Botto, M. Luzi, Ospedale S.Anna—Como; C. Perrone, A. Zorzi, Ospedale Civile - Arzignano; G. Mantovani, P. Bertocchi, Ospedale di Circolo - Desio (MI); R. Massa, P. Golzio, C. Amellone, Az. Osp. Molinette S.Giovanni Battista—Torino; A. Gavazzi, F. Cantù, M. Senni, Ospedali Riuniti—Bergamo; A. Sorgato, M. Pezzali, Osp. S. Orsola-Fatebenefratelli—Brescia; G. Capella, R. Fornerone, Ospedale Fatebenefratelli e Oftalmico—Milano; M. Pasqualini, D. Pozzetti, Azienda Ospedaliera Carlo Poma Pieve di Coriano; S. Lombroso, E. Petrucci, Ospedale di Circolo - Busto Arsizio; E. Di Girolamo, P. Sabatini, Ospedale SS. Annunziata—Chieti; P. Spirito, D. Molini, Ente Ospedaliero Ospedali Galliera—Genova; P. Gelmini, T. Bignotti, Ospedale di Desenzano - Desenzano del Garda; G. Senatore, G. Trapani, M. Giuggia, Presidio Ospedaliero Riunito—Ciriè; M. Zanetta, A. Perucca, U. Parravicini, Presidio Ospedaliero SS. Trinita—Borgomanero

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Perego, G.B., Landolina, M., Vergara, G. et al. Implantable CRT device diagnostics identify patients with increased risk for heart failure hospitalization. J Interv Card Electrophysiol 23, 235–242 (2008). https://doi.org/10.1007/s10840-008-9303-5

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  • DOI: https://doi.org/10.1007/s10840-008-9303-5

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