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

  • Giovanni B. Perego
  • Maurizio Landolina
  • Giuseppe Vergara
  • Maurizio Lunati
  • Gabriele Zanotto
  • Alessia Pappone
  • Gabriele Lonardi
  • Giancarlo Speca
  • Saverio Iacopino
  • Annamaria Varbaro
  • Shantanu Sarkar
  • Doug A. Hettrick
  • Alessandra Denaro
  • Optivol-CRT Clinical Service Observational Group
Article

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.

Keywords

Impedance Arrhythmias Heart rate variability Heart rate Activity Cardiac resynchronization therapy Heart failure 

Notes

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.

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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Giovanni B. Perego
    • 1
    • 12
  • Maurizio Landolina
    • 2
  • Giuseppe Vergara
    • 3
  • Maurizio Lunati
    • 4
  • Gabriele Zanotto
    • 5
  • Alessia Pappone
    • 6
  • Gabriele Lonardi
    • 7
  • Giancarlo Speca
    • 8
  • Saverio Iacopino
    • 9
  • Annamaria Varbaro
    • 10
  • Shantanu Sarkar
    • 11
  • Doug A. Hettrick
    • 11
  • Alessandra Denaro
    • 10
  • Optivol-CRT Clinical Service Observational Group
  1. 1.Istituto Auxologico S. LucaMilanItaly
  2. 2.Fondazione Policlinico S. Matteo IRCCSPaviaItaly
  3. 3.Ospedale Santa Maria del CarmineRoveretoItaly
  4. 4.Ospedale NiguardaMilanItaly
  5. 5.Ospedale Civile Maggiore di Borgo TrentoVeronaItaly
  6. 6.IRCCS S. RaffaeleMilanItaly
  7. 7.Ospedale Mater SalutisLegnagoItaly
  8. 8.Ospedale Civile G. MazziniTeramoItaly
  9. 9.S. Anna HospitalCatanzaroItaly
  10. 10.Medtronic ItaliaRomeItaly
  11. 11.Medtronic Inc.MinneapolisUSA
  12. 12.Ospedale S. LucaMilanItaly

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