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

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...

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Published in:Journal of interventional cardiac electrophysiology 2008-12, Vol.23 (3), p.235-242
Main Authors: Perego, Giovanni B., Landolina, Maurizio, Vergara, Giuseppe, Lunati, Maurizio, Zanotto, Gabriele, Pappone, Alessia, Lonardi, Gabriele, Speca, Giancarlo, Iacopino, Saverio, Varbaro, Annamaria, Sarkar, Shantanu, Hettrick, Doug A., Denaro, Alessandra
Format: Article
Language:English
Subjects:
Aged
Cardiac Pacing, Artificial - methods
Cardiography, Impedance
Cardiology
Female
Heart Failure - diagnosis
Heart Failure - physiopathology
Heart Failure - therapy
Heart Rate - physiology
Hospitalization
Humans
Logistic Models
Male
Medicine
Medicine & Public Health
Poisson Distribution
Prospective Studies
Risk
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Summary: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.
ISSN:1383-875X
1572-8595
DOI:10.1007/s10840-008-9303-5