Intrathoracic impedance monitoring to detect chronic heart failure deterioration: relationship to changes in NT-proBNP.
BACKGROUND
An alert algorithm, based on intrathoracic impedance monitoring, has been incorporated into a cardiac resynchronisation device (CRT) to detect pulmonary fluid accumulation, and to audibly alert patients to decompensating chronic heart failure (CHF).


OBJECTIVE
To evaluate this algorithm, alert events were correlated with changes in NT-proBNP concentration and CHF status.


RESULTS
In a prospective observational study of 62 patients (89% male, aged 67+/-1 year), NT-proBNP plasma concentrations, clinical CHF status, and device data were collected at enrolment, during regular follow-up and at device alerts. Over a mean follow-up of 27+/-2 weeks, pooled data indicated a weak, but significant inverse relationship between relative changes in intrathoracic impedance and NT-proBNP (r=-0.3; p<0.001). In 52 device alerts from 35 patients, NT-proBNP increased by 66+/-19% from 2039+/-331 pg/ml (p<0.001). The increase in NT-proBNP was higher in alerts with clinical signs of CHF deterioration (n=30, 89+/-25%; p<0.001) than in alert events without clinical signs (n=22, 25+/-15%; p=n.s.).


CONCLUSIONS
Intrathoracic impedance based alert events are associated with a significant increase in NT-proBNP concentration. These data indicate that intrathoracic impedance monitoring might facilitate the outpatient management of CHF patients with implanted CRT devices.
Lüthje
Lars
L
Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. larsluethje@med.uni-goettingen.de <larsluethje@med.uni-goettingen.de>
Vollmann
Dirk
D
Drescher
Till
T
Schott
Peter
P
Zenker
Dieter
D
Hasenfuss
Gerd
G
Unterberg
Christina
C
D000368:Aged; D000465:Algorithms; D002307:Cardiography, Impedance / Q000295:instrumentation*; D002908:Chronic Disease; D017147:Defibrillators, Implantable; D018450:Disease Progression; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D008991:Monitoring, Physiologic; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012984:Software
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain