title: Long-term effectiveness of the combined minute ventilation and patient activity sensors as predictor of heart failure events in patients treated with cardiac resynchronization therapy: Results of the Clinical Evaluation of the Physiological Diagnosis Function in the PARADYM CRT device Trial (CLEPSYDRA) study.
abstract: OBJECTIVE
  Monitoring early signs of clinical deterioration could allow physicians to adjust medical treatment for patients at risk of acute heart failure decompensation. To date, several strategies using different surrogate measures of clinical status emerged, but none has yet been proven to predict clinical events. We hypothesized that the Physiological Diagnostic feature, which combines data from minute ventilation and physical activity sensors, predicts heart failure events in patients implanted with cardiac resynchronization therapy with defibrillation (CRT-D) devices.
  
  
  RESULTS
  The Clinical Evaluation of the Physiological Diagnostic feature in the PARADYM CRT device (CLEPSYDRA) trial is a multicentre, prospective, non-randomized, double-blind study comprising 521 CRT-D patients with heart failure [67.4 ± 10.1 years (mean ± SD), 82% male, New York Heart Association class III/IV 85.0%/6.7%, QRS 155.3 ± 26.6 ms, left ventricular ejection fraction 25.7 ± 7.7%]. The objective of the study was the sensitivity and false positive rate of the Physiological Diagnostic algorithm to predict heart failure events within the following month. After a mean follow-up of 17.0 ± 8.7 months, 130 (25.6%) patients experienced a heart failure event. The sensitivity of the algorithm to predict an event was 34% and the false positive rate was 2.4 per patient-year.
  
  
  CONCLUSIONS
  Thirty-four per cent of heart failure events occurring within a month were predicted by the Physiological Diagnostic algorithm, and 2.4 alerts per patient per year were not followed by an heart failure event within the subsequent month.
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
authors.forename: Michael R
authors.initials: MR
authors.lastname: Gold
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: G
authors.initials: G
authors.lastname: Nölker
authors.forename: Siva
authors.initials: S
authors.lastname: Arunasalam
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calò
authors.forename: Oliver
authors.initials: O
authors.lastname: Baumann
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D058406:Cardiac Resynchronization Therapy; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D011446:Prospective Studies; D012129:Respiratory Function Tests / Q000379:methods*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Activity; Cardiac resynchronization therapy; Heart failure monitoring; Minute ventilation; Predictive algorithm