Analysis of Different Device-Based Intrathoracic Impedance Vectors for Detection of Heart Failure Events (from the Detect Fluid Early from Intrathoracic Impedance Monitoring Study)

Heist, E. Kevin; Herre, John M.; Binkley, Philip F.; Bakel, Adrian B. Van; Porterfield, James G.; Porterfield, Linda M.; Qu, Fujian; Turkel, Melanie; Pavri, Behzad B.

doi:10.1016/j.amjcard.2014.07.048

Cited by 52 publications

(31 citation statements)

References 19 publications

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“…This is also consistent with clinical practice where no single sign or symptom is interpreted in isolation but in the context of all available clinical data. This may partly explain why single sensors that target individual sign or symptom, such as impedance for volume status, and minute ventilation and activity for exertion dyspnoea have had modest performance . A Heart Sound sensor provides an opportunity to target multiple aspects of HF pathophysiology given the differential haemodynamic correlates of various HS amplitude and timing parameters.…”

Section: Discussionmentioning

confidence: 99%

“…This may partly explain why single sensors that target individual sign or symptom, such as impedance for volume status, and minute ventilation and activity for exertion dyspnoea have had modest performance. [30][31][32] A Heart Sound sensor provides an opportunity to target multiple aspects of HF pathophysiology given the differential haemodynamic correlates of various HS amplitude and timing parameters. The HS measured using an existing accelerometer within the implanted cardiac devices may aid in building a more holistic picture of patients clinical status without additional hardware or surgery.…”

Section: Implications For Chronic Monitoring Of Heart Failure Patientsmentioning

confidence: 99%

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Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device

Thakur

Swanson

et al. 2017

ESC Heart Failure

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AimThe aim of this study was to evaluate the haemodynamic correlates of heart sound (HS) parameters such as third HS (S3), first HS (S1), and HS‐based systolic time intervals (HSTIs) from an implantable cardiac device.Methods and resultsTwo unique animal models (10 swine with myocardial ischaemia and 11 canines with pulmonary oedema) were used to evaluate haemodynamic correlates of S1, S3, and HSTIs, namely, HS‐based pre‐ejection period (HSPEP), HS‐based ejection time (HSET), and the ratio HSPEP/HSET during acute haemodynamic perturbations. The HS was measured using implanted cardiac resynchronization therapy defibrillator devices simultaneously with haemodynamic references such as left atrial (LA) pressure and left ventricular (LV) pressure. In the ischaemia model, S1 amplitude (r = 0.76 ± 0.038; P = 0.002), HSPEP (r = −0.56 ± 0.07; P = 0.002), and HSPEP/HSET (r = −0.42 ± 0.1; P = 0.002) were significantly correlated with LV dP/dtmax. In contrast, HSET was poorly correlated with LV dP/dtmax (r = 0.14 ± 0.14; P = 0.23). In the oedema model, a physiological delayed response was observed in S3 amplitude after acute haemodynamic perturbations. After adjusting for the delay, S3 amplitude significantly correlated with LA pressure in individual animals (r = 0.71 ± 0.07; max: 0.92; min: 0.17) as well as in aggregate (r = 0.62; P < 0.001). The S3 amplitude was able to detect elevated LA pressure, defined as >25 mmHg, with a sensitivity = 58% and specificity = 90%.ConclusionsThe HS parameters such as S1, S3, and HSTIs measured using implantable devices significantly correlated with haemodynamic changes in acute animal models, suggesting potential utility for remote heart failure patient monitoring.

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Section: Discussionmentioning

confidence: 99%

Section: Implications For Chronic Monitoring Of Heart Failure Patientsmentioning

confidence: 99%

Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device

Thakur

Swanson

et al. 2017

ESC Heart Failure

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“…But this point is not supported by the recent published data. A multicenter prospective study aiming to optimize vector configuration of ITI monitoring algorithm of St. Jude devices resulted in low sensitivity for HF event prediction . The LIMIT‐CHF trial, which included more than 50% of the patients with St. Jude Medical ICD or CRT‐D devices with CorVue™ algorithm, failed to show the benefit of empirical diuretic therapy guided by ITI monitor alerts in chronic HF patients to prevent HF hospitalization and unplanned HF care .…”

Section: Discussionmentioning

confidence: 99%

CorVue algorithm efficacy to predict heart failure in real life: Unnecessary and potentially misleading information?

Palfy

Bénézet-Mazuecos

Milla

et al. 2018

Pacing Clinical Electrophis

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“…In addition, external and implanted impedance measurement devices have been proposed as potential future tools in the assessment of pulmonary congestion . These devices have been investigated as assessment and monitoring devices for pulmonary oedema, although with inconsistent findings with respect to their diagnostic and prognostic utility in HF populations …”

Section: Discussionmentioning

confidence: 99%

Assessment and prevalence of pulmonary oedema in contemporary acute heart failure trials: a systematic review

Platz

Jhund

Campbell

et al. 2015

European J of Heart Fail

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Aims Pulmonary oedema is a common and important finding in acute heart failure (AHF). We conducted a systematic review to describe the methods used to assess pulmonary oedema in recent randomized AHF trials and report its prevalence in these trials. Methods and results Of 23 AHF trials published between 2002 and 2013, six were excluded because they were very small or not randomized, or missing full-length publications. Of the remaining 17 (n = 200–7141) trials, six enrolled patients with HF and reduced ejection fraction (HF-REF) and 11, patients with both HF-REF and HF with preserved ejection fraction (HF-PEF). Pulmonary oedema was an essential inclusion criterion, in most trials, based upon findings on physical examination (‘rales’), radiographic criteria (‘signs of congestion’), or both. The prevalence of pulmonary oedema in HF-REF trials ranged from 75% to 83% and in combined HF-REF and HF-PEF trials from 51% to 100%. Five trials did not report the prevalence or extent of pulmonary oedema assessed by either clinical examination or chest x-ray. Improvement of pulmonary congestion with treatment was inconsistently reported and commonly grouped with other signs of congestion into a score. One trial suggested that patients with rales over >2/3 of the lung fields on admission were at higher risk of adverse outcomes than those without. Conclusion Although pulmonary oedema is a common finding in AHF, represents a therapeutic target, and may be of prognostic importance, recent trials used inconsistent criteria to define it, and did not consistently report its severity at baseline or its response to treatment. Consistent and ideally quantitative, methods for the assessment of pulmonary oedema in AHF trials are needed.

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Analysis of Different Device-Based Intrathoracic Impedance Vectors for Detection of Heart Failure Events (from the Detect Fluid Early from Intrathoracic Impedance Monitoring Study)

Cited by 52 publications

References 19 publications

Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device

Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device

CorVue algorithm efficacy to predict heart failure in real life: Unnecessary and potentially misleading information?

Assessment and prevalence of pulmonary oedema in contemporary acute heart failure trials: a systematic review

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