title: Decreased Intrathoracic Impedance Associated With OptiVol Alert Can Diagnose Increased B-Type Natriuretic Peptide - MOMOTARO (Monitoring and Management of OptiVol Alert to Reduce Heart Failure Hospitalization) Study - .
abstract: BACKGROUND
  Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device may detect increases in pulmonary fluid retention early, but the clinical utility of this method is not well established. The goal of this study was to test whether conventional ITI-derived parameters can diagnose fluid retention that may cause early stage heart failure (HF).
  
  
  RESULTS
  HF patients implanted with high-energy devices with OptiVol (Medtronic) monitoring were enrolled in this study. Patients were monitored remotely. At both baseline and OptiVol alert, patients were assessed on standard examinations, including analysis of serum brain natriuretic peptide (BNP). From April 2010 to August 2011, 195 patients from 12 institutes were enrolled. There were 154 primary OptiVol alert events. BNP level at the alerts was not significantly different from that at baseline. Given that ITI was inversely correlated with log BNP, we added a criterion specifying that the OptiVol alert is triggered only when ITI decreases by ≥4% from baseline. This change improved the diagnostic potential of increase in BNP at OptiVol alert (sensitivity, 75%; specificity, 88%).
  
  
  CONCLUSIONS
  BNP increase could not be identified based on OptiVol alert. Decrease in ITI ≥4% compared with baseline, in addition to the alert, however, may be a useful marker for the likelihood of HF (Clinical trial info: UMIN000003351).
authors: Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences.
authors: Nobuhiro
authors: N
authors: Nishii
authors: Motoki
authors: M
authors: Kubo
authors: Yoji
authors: Y
authors: Okamoto
authors: Satoki
authors: S
authors: Fujii
authors: Atsuyuki
authors: A
authors: Watanabe
authors: Yuko
authors: Y
authors: Toyama
authors: Tadakatsu
authors: T
authors: Yamada
authors: Masayuki
authors: M
authors: Doi
authors: Hiroshi
authors: H
authors: Morita
authors: Hiroshi
authors: H
authors: Ito
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D058406:Cardiac Resynchronization Therapy; D002307:Cardiography, Impedance / Q000295:instrumentation / Q000379:methods*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D056902:Clinical Alarms; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable; D017097:Electric Impedance; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D006333:Heart Failure / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012372:ROC Curve; D017216:Telemedicine / Q000295:instrumentation; D014682:Vena Cava, Inferior / Q000648:ultrastructure; D015430:Weight Gain
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D020097:Natriuretic Peptide, Brain