Predictive Value of OptiVol Fluid Index and Baseline BNP Value on Heart Failure in Remote Monitoring Patients

概要

論文の詳細を見る
Background: Increasing number of pacemakers and implantable cardioverter defibrillators (ICD) are managed with remote monitoring system. Intrathoracic impedance monitoring system (OptiVol fluid index) is incorporated into some of these devices, but its utility in heart failure management in everyday practice in unknown. Methods: Twenty-five patients (19 men, aged 64±15 years) with implantable devise capable of OptiVol fluid monitoring, who are participating in the remote monitoring system (CareLink) at our hospital were enrolled. Cut-off value of OptiVol index were set at 60 ohm∗day. Results: Three heart failure hospitalizations were observed, but only 1 was during a high OptiVol episode (sensitivity: 33.3%, positive predictive value (PPV): 3.4%). Of the high OptiVol episodes, 24 with records of BNP values before and during the episodes were evaluated. BNP values were increased by 154±175 pg/ml during the high OptiVol episodes. Patients with baseline BNP<100 pg/ml (low-BNP group, n=8), when compared to patients with baseline BNP>100 pg/ml (high-BNP group, n=16), had significantly lower increase of BNP during the high OptiVol episodes (42.1 vs 209.4 pg/ml, p=<0.01). Conclusion: OptiVol index>60 ohm ∗ day had poor PPV for heart failure hospitalization. BNP value was increased in most high OptiVol episodes, but in patients with low baseline BNP value, the degree of the increase was very low, and unclinical.