Hemodynamic Factors Associated With Acute Decompensated Heart Failure: Part 2—Use in Automated Detection

详细信息    查看全文

• 作者：Philip B. Adamson MD¹ ; Michael R. Zile MD² ; ^{zilem@musc.edu"" rel=""nofollow} ; Yong K. Cho PhD³ ; Tom D. Bennett PhD³ ; Robert C. Bourge MD⁴ ; Mark F. Aaron MD⁵ ; Juan M. Aranda Jr. MD⁶ ; William T. Abraham MD⁷ ; Fred J. Kueffer MS³ ; Robert T. Taepke MS³
• 关键词：Heart failure ; hemodynamics ; acute decompensation
• 刊名：Journal of Cardiac Failure
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：17
• 期：5
• 页码：366-373
• 全文大小：277 K

文摘

Background

The purpose of this study was to develop an automated surveillance system, using pressure-based hemodynamic factors that would detect which patients were making the transition from compensated to decompensated heart failure before they developed worsening symptoms and required acute medical care.

Methods and Results

Intracardiac pressures in 274 patients with heart failure were measured using an implantable hemodynamic monitor (IHM) and were analyzed in a retrospective manner. An automated pressure change detection (PCD) algorithm was developed using the cumulative sum method. The performance characteristics of the PCD algorithm were defined in all patients who developed a heart failure–related event (HFRE); patients without HFRE served as controls. Optimal PCD threshold values were chosen using a receiver operator curve analysis. Each of the pressures measured with the IHM were evaluated using the PCD analysis. All had sensitivities ≥80 % and false-positive rates <4.7/patient-year; however, estimated pulmonary artery diastolic pressure (ePAD) had the best performance. An ePAD based on the optimized PCD threshold of 6.0 yielded a sensitivity of 83 % and a false-positive rate of 4.1/patient-year for detecting patients making the transition from compensated to decompensated heart failure. These performance characteristics were not significantly different for patients with an ejection fraction > vs. <50 % , estimated glomerular filtration rate > vs. <60 mL/min/1.73 m², or age > vs. <60 years.

Conclusions

The automated PCD algorithm had high sensitivity and acceptable false-positive rates in detecting the development of decompensated heart failure before the patient developed worsening symptoms and required acute medical care. These data support the development of a prospective study to examine the utility of adding an automated PCD algorithm to IHM-based management strategies to prevent decompensated heart failure.