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Tedeschi A, Palazzini M, Trimarchi G, Conti N, Di Spigno F, Gentile P, D’Angelo L, Garascia A, Ammirati E, Morici N, Aschieri D. Heart Failure Management through Telehealth: Expanding Care and Connecting Hearts. J Clin Med 2024; 13:2592. [PMID: 38731120 PMCID: PMC11084728 DOI: 10.3390/jcm13092592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Heart failure (HF) is a leading cause of morbidity worldwide, imposing a significant burden on deaths, hospitalizations, and health costs. Anticipating patients' deterioration is a cornerstone of HF treatment: preventing congestion and end organ damage while titrating HF therapies is the aim of the majority of clinical trials. Anyway, real-life medicine struggles with resource optimization, often reducing the chances of providing a patient-tailored follow-up. Telehealth holds the potential to drive substantial qualitative improvement in clinical practice through the development of patient-centered care, facilitating resource optimization, leading to decreased outpatient visits, hospitalizations, and lengths of hospital stays. Different technologies are rising to offer the best possible care to many subsets of patients, facing any stage of HF, and challenging extreme scenarios such as heart transplantation and ventricular assist devices. This article aims to thoroughly examine the potential advantages and obstacles presented by both existing and emerging telehealth technologies, including artificial intelligence.
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Affiliation(s)
- Andrea Tedeschi
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (F.D.S.); (D.A.)
| | - Matteo Palazzini
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy;
| | - Nicolina Conti
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Francesco Di Spigno
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (F.D.S.); (D.A.)
| | - Piero Gentile
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Luciana D’Angelo
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Andrea Garascia
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Enrico Ammirati
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Nuccia Morici
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
| | - Daniela Aschieri
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (F.D.S.); (D.A.)
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Lindenfeld J, Costanzo MR, Zile MR, Ducharme A, Troughton R, Maisel A, Mehra MR, Paul S, Sears SF, Smart F, Johnson N, Henderson J, Adamson PB, Desai AS, Abraham WT. Implantable Hemodynamic Monitors Improve Survival in Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol 2024; 83:682-694. [PMID: 38325994 DOI: 10.1016/j.jacc.2023.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Trials evaluating implantable hemodynamic monitors to manage patients with heart failure (HF) have shown reductions in HF hospitalizations but not mortality. Prior meta-analyses assessing mortality have been limited in construct because of an absence of patient-level data, short-term follow-up duration, and evaluation across the combined spectrum of ejection fractions. OBJECTIVES The purpose of this meta-analysis was to determine whether management with implantable hemodynamic monitors reduces mortality in patients with heart failure and reduced ejection fraction (HFrEF) and to confirm the effect of hemodynamic-monitoring guided management on HF hospitalization reduction reported in previous studies. METHODS The patient-level pooled meta-analysis used 3 randomized studies (GUIDE-HF [Hemodynamic-Guided Management of Heart Failure], CHAMPION [CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients], and LAPTOP-HF [Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy]) of implantable hemodynamic monitors (2 measuring pulmonary artery pressures and 1 measuring left atrial pressure) to assess the effect on all-cause mortality and HF hospitalizations. RESULTS A total of 1,350 patients with HFrEF were included. Hemodynamic-monitoring guided management significantly reduced overall mortality with an HR of 0.75 (95% CI: 0.57-0.99); P = 0.043. HF hospitalizations were significantly reduced with an HR of 0.64 (95% CI: 0.55-0.76); P < 0.0001. CONCLUSIONS Management of patients with HFrEF using an implantable hemodynamic monitor significantly reduces both mortality and HF hospitalizations. The reduction in HF hospitalizations is seen early in the first year of monitoring and mortality benefits occur after the first year.
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Affiliation(s)
- JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | | | - Michael R Zile
- Medical University of South Carolina, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Caroline, USA
| | - Anique Ducharme
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Richard Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Alan Maisel
- University of California San Diego, La Jolla, California, USA
| | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sara Paul
- Catawba Valley Health System, Conover, North Carolina, USA
| | - Samuel F Sears
- East Carolina University, Greenville, North Carolina, USA
| | - Frank Smart
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | | | | | | | - Akshay S Desai
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Leavitt MA. CE: Guideline-Directed Cardiac Devices for Patients with Heart Failure. Am J Nurs 2022; 122:24-31. [PMID: 35551123 DOI: 10.1097/01.naj.0000832724.08294.fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Heart failure affects over 6.2 million adults in the United States and is expected to affect over 8 million by 2030. The U.S. one-year mortality rate is almost 30% among Medicare beneficiaries. Technological advances have produced several new cardiac devices that are available for therapy and symptom management. This article reviews current device therapies for heart failure and uses a composite case to demonstrate how bedside nurses can help patients understand treatment options related to their disease process and care for them through this experience.
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Affiliation(s)
- Mary Ann Leavitt
- Mary Ann Leavitt is an assistant professor at the Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton. Contact author: . The author and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the author is available at www.ajnonline.com
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Ahmed FZ, Sammut-Powell C, Kwok CS, Tay T, Motwani M, Martin GP, Taylor JK. Remote monitoring data from cardiac implantable electronic devices predicts all-cause mortality. Europace 2021; 24:245-255. [PMID: 34601572 PMCID: PMC8824524 DOI: 10.1093/europace/euab160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
Aims To determine if remotely monitored physiological data from cardiac implantable electronic devices (CIEDs) can be used to identify patients at high risk of mortality. Methods and results This study evaluated whether a risk score based on CIED physiological data (Triage-Heart Failure Risk Status, ‘Triage-HFRS’, previously validated to predict heart failure (HF) events) can identify patients at high risk of death. Four hundred and thirty-nine adults with CIEDs were prospectively enrolled. Primary observed outcome was all-cause mortality (median follow-up: 702 days). Several physiological parameters [including heart rate profile, atrial fibrillation/tachycardia (AF/AT) burden, ventricular rate during AT/AF, physical activity, thoracic impedance, therapies for ventricular tachycardia/fibrillation] were continuously monitored by CIEDs and dynamically combined to produce a Triage-HFRS every 24 h. According to transmissions patients were categorized into ‘high-risk’ or ‘never high-risk’ groups. During follow-up, 285 patients (65%) had a high-risk episode and 60 patients (14%) died (50 in high-risk group; 10 in never high-risk group). Significantly more cardiovascular deaths were observed in the high-risk group, with mortality rates across groups of high vs. never-high 10.3% vs. <4.0%; P = 0.03. Experiencing any high-risk episode was associated with a substantially increased risk of death [odds ratio (OR): 3.07, 95% confidence interval (CI): 1.57–6.58, P = 0.002]. Furthermore, each high-risk episode ≥14 consecutive days was associated with increased odds of death (OR: 1.26, 95% CI: 1.06–1.48; P = 0.006). Conclusion Remote monitoring data from CIEDs can be used to identify patients at higher risk of all-cause mortality as well as HF events. Distinct from other prognostic scores, this approach is automated and continuously updated.
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Affiliation(s)
- Fozia Zahir Ahmed
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Camilla Sammut-Powell
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chun Shing Kwok
- School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Tricia Tay
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Manish Motwani
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Joanne K Taylor
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Matteucci A, Bonanni M, Centioni M, Zanin F, Geuna F, Massaro G, Sangiorgi G. Home Management of Heart Failure and Arrhythmias in Patients with Cardiac Devices during Pandemic. J Clin Med 2021; 10:jcm10081618. [PMID: 33920350 PMCID: PMC8069073 DOI: 10.3390/jcm10081618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/22/2022] Open
Abstract
Background: The in-hospital management of patients with cardiac implantable electronic devices (CIEDs) changed early in the COVID-19 pandemic. Routine in-hospital controls of CIEDs were converted into remote home monitoring (HM). The aim of our study was to investigate the impact of the lockdown period on CIEDs patients and its influence on in-hospital admissions through the analysis of HM data. Methods: We analysed data recorded from 312 patients with HM during the national quarantine related to COVID-19 and then compared data from the same period of 2019. Results: We observed a reduction in the number of HM events in 2020 when compared to 2019. Non-sustained ventricular tachycardia episodes decreased (18.3% vs. 9.9% p = 0.002) as well as atrial fibrillation episodes (29.2% vs. 22.4% p = 0.019). In contrast, heart failure (HF) alarm activation was lower in 2019 than in 2020 (17% vs. 25.3% p = 0.012). Hospital admissions for critical events recorded with CIEDs dropped in 2020, including those for HF. Conclusions: HM, combined with telemedicine use, has ensured the surveillance of CIED patients. In 2020, arrhythmic events and hospital admissions decreased significantly compared to 2019. Moreover, in 2020, patients with HF arrived in hospital in a worse clinical condition compared to previous months.
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Affiliation(s)
- Andrea Matteucci
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
- Correspondence: ; Tel.: +39-06-2090-4044
| | - Michela Bonanni
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
| | - Marco Centioni
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
| | - Federico Zanin
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
| | - Francesco Geuna
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.B.); (M.C.); (F.Z.); (F.G.)
| | - Gianluca Massaro
- Division of Cardiology, University Hospital “Tor Vergata”, 00133 Rome, Italy;
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy;
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Zile MR, Costanzo MRR, Ippolito EM, Zhang Y, Stapleton R, Sadhu A, Jimenez J, Hobbs J, Sharma V, Warman EN, Streeter L, Butler J. INTERVENE-HF: feasibility study of individualized, risk stratification-based, medication intervention in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:849-860. [PMID: 33527654 PMCID: PMC8006696 DOI: 10.1002/ehf2.13231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/18/2020] [Accepted: 01/19/2021] [Indexed: 12/04/2022] Open
Abstract
Aims Determine the feasibility of implementing a heart failure (HF) management strategy that (i) uses a device‐based, remote, dynamic, multimetric risk stratification model to predict the risk of HF events and (ii) uses a standardized, centrally administered, ambulatory medication intervention protocol to reproducibly and safely decrease elevated risk scores. Methods and results Prospective, non‐randomized, single‐arm, multicenter feasibility study (Intervene‐HF) was conducted in HF patients implanted with a cardiac resynchronization therapy with implantable cardio defibrillator (CRT‐D) with TriageHF risk score feature. Certified HF nurses (CHFN) in the Medtronic Care Management Services Program implemented an ambulatory medication intervention strategy by following a standardized guided action pathway triggered by risk‐based alert. When CHFN received notification of increased risk score (HF care alert), they implemented a 3 day course of diuretic up‐titration (PRN) previously prescribed by a physician. Safety was monitored daily. Recovery after PRN was defined as ≥70% recovery of impedance toward baseline levels. Sixty‐six patients followed for 8.2 ± 3.9 months had 49 HF care alerts. Twenty‐three of 49 alerts did not receive PRN due to protocol‐mandated criteria. Twenty‐six of 49 alerts received PRN, 22 were completed, and 19 led to impedance recovery. Four interventions were stopped for safety without leading to an adverse event (AE). One of 26 PRNs was followed by a HF event. Eighty‐five per cent (22/26) of PRNs were completed without an AE; 69% (18/26) met the recovery criteria. Conclusions The Intervene‐HF study supports the feasibility of testing, in a large randomized clinical trial, an ambulatory medication intervention strategy that is physician‐directed, CHFN‐implemented, and based on individualized device risk stratification.
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Affiliation(s)
- Michael R Zile
- RJH Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | - Ashish Sadhu
- Heart and Vascular Center of Arizona, Phoenix, AZ, USA
| | | | | | | | | | | | - Javed Butler
- University of Mississippi Medical Center, University of Mississippi, Jackson, MS, USA
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Al‐Damluji MS, Singhvi A, Snuckel M, Zaghloul A, Kluger J. Do ICD diagnostics predict failure of ventricular tachycardia response to antitachycardia pacing and need for shock? Pacing Clin Electrophysiol 2020; 43:1302-1308. [DOI: 10.1111/pace.14002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Aditi Singhvi
- Cardiovascular Medicine Hartford Hospital Hartford Connecticut
| | - Meghan Snuckel
- Internal Medicine University of Connecticut Health Center Farmington Connecticut
| | - Ahmed Zaghloul
- Cardiovascular Medicine University of Iowa Iowa City Iowa
| | - Jeffrey Kluger
- Cardiovascular Medicine Hartford Hospital Hartford Connecticut
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Zile MR, Sharma V, Baicu CF, Koehler J, Tang AS. Prediction of heart failure hospitalizations based on the direct measurement of intrathoracic impedance. ESC Heart Fail 2020; 7:3040-3048. [PMID: 32790059 PMCID: PMC7524260 DOI: 10.1002/ehf2.12930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/28/2020] [Accepted: 07/16/2020] [Indexed: 12/04/2022] Open
Abstract
Aims OptiVol fluid index was developed as a transthoracic impedance‐based indicator of short‐term risk for heart failure hospitalization (HFH). OptiVol is calculated as the accumulating difference between daily impedance (measured impedance) and long‐term average impedance (reference impedance). Measured impedance alone was thought to have limited prognostic utility; however, measured impedance has the advantage of being simple, direct, and possibly additive to OptiVol fluid index in establishing long‐term HFH risk. We tested the hypothesis that directly measured impedance has independent prognostic value in predicting long‐term HFH risk and that changes in measured impedance result in a change in predicted long‐term HFH risk. Methods and results A retrospective analysis of 1719 patients studied in PARTNERS‐HF, FAST, and RAFT studies was performed. Baseline measured impedance was determined using daily values averaged over 1 month, from Month 6 to 7 post implant; change in measured impedance was determined from values averaged over 1 month, from Month 7 to 8 post implant compared with baseline. The predictive value of baseline measured impedance for HFHs was assessed beginning 7 months post implant. The predictive value of a change in measured impedance for a change in HFHs was assessed beginning 8 months post implant. Baseline measured impedance successfully predicted HFHs. For example, 3 year HFH rate for low baseline impedance < 70 Ω was 23%; for high baseline impedance ≥ 70 Ω was 15% (P < 0.001). Changes in measured impedance resulted in changes in predicted HFHs. For example, when a baseline impedance of ≥70 fell during follow‐up to <70 Ω, the subsequent HFHs were 15% compared with 4% in patients with measured impedance that remained >70 Ω (P = 0.004). In addition, when baseline measured impedance fell during follow‐up by >1%, 2%, or 3%, subsequent HFHs increased to 13%, 17%, or 18%, respectively. Finally, the prognostic value of measured impedance was additive to the prognostic value of the OptiVol fluid index. Conclusions Direct measurements of intrathoracic impedance using an implanted device can be used to stratify patients at varying risk of long‐term HFH. These direct measurements of impedance have practical clinical appeal because they are simple, continuous, and ambulatory.
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Affiliation(s)
- Michael R Zile
- Division of Cardiology, Department of Medicine, Medical University of South Carolina and RHJ Department of Veterans Affairs Medical Center, Charleston, SC, 29425, USA
| | | | - Catalin F Baicu
- Division of Cardiology, Department of Medicine, Medical University of South Carolina and RHJ Department of Veterans Affairs Medical Center, Charleston, SC, 29425, USA
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Rangaswami J, Bhalla V, Blair JEA, Chang TI, Costa S, Lentine KL, Lerma EV, Mezue K, Molitch M, Mullens W, Ronco C, Tang WHW, McCullough PA. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e840-e878. [PMID: 30852913 DOI: 10.1161/cir.0000000000000664] [Citation(s) in RCA: 555] [Impact Index Per Article: 138.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiorenal syndrome encompasses a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in 1 organ may induce acute or chronic dysfunction in the other organ. It represents the confluence of heart-kidney interactions across several interfaces. These include the hemodynamic cross-talk between the failing heart and the response of the kidneys and vice versa, as well as alterations in neurohormonal markers and inflammatory molecular signatures characteristic of its clinical phenotypes. The mission of this scientific statement is to describe the epidemiology and pathogenesis of cardiorenal syndrome in the context of the continuously evolving nature of its clinicopathological description over the past decade. It also describes diagnostic and therapeutic strategies applicable to cardiorenal syndrome, summarizes cardiac-kidney interactions in special populations such as patients with diabetes mellitus and kidney transplant recipients, and emphasizes the role of palliative care in patients with cardiorenal syndrome. Finally, it outlines the need for a cardiorenal education track that will guide future cardiorenal trials and integrate the clinical and research needs of this important field in the future.
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Pusceddu I, Dieplinger B, Mueller T. ST2 and the ST2/IL-33 signalling pathway-biochemistry and pathophysiology in animal models and humans. Clin Chim Acta 2019; 495:493-500. [PMID: 31136737 DOI: 10.1016/j.cca.2019.05.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/26/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022]
Abstract
ST2 is an interleukin (IL)-1 receptor family member with transmembrane (ST2L) and soluble (sST2) isoforms. Structurally, the ST2 gene products are very similar in mice and humans. In humans and in mice, alternative promoter activation and splicing produce ST2L and sST2. ST2L represents the longest transcript, whereas sST2 is the truncated, soluble isoform. ST2L is the biological receptor for IL-33, a member of the IL-1 family. IL-33 is the functional ligand of ST2L and signals the presence of tissue damage to local immune cells. IL-33/ST2L signalling leads to the production of inflammatory cytokines/chemokines and to the induction of the immune response. Conversely, sST2 functions as a decoy receptor for IL-33, inhibiting the effects of IL-33/ST2L signalling. Animal studies have allowed the investigation of ST2 and the IL-33/ST2L signalling pathway at multiple levels. However, clinical studies have mainly focused on the determination of sST2 in the circulation. In humans, plasma concentrations of sST2 increase in several diseases, such as heart disease, pulmonary disease, burn injury and graft-versus-host disease. Consequently, increased plasma concentrations of sST2 are not specific for a single disorder in humans and are thus of limited value for diagnostic purposes. However, increased plasma concentrations of sST2 have been linked to a worse prognosis in numerous diseases. Nevertheless, the major source of circulating sST2 in healthy and diseased humans is currently not fully established. In addition, whether the downregulation of sST2 can improve the outcome of patients in the clinical setting has not been elucidated. The aim of the present review was to provide an update on the findings regarding the biochemistry and pathophysiology of ST2 and the sST2 signalling pathway in humans and experimental models.
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Affiliation(s)
- Irene Pusceddu
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy
| | - Benjamin Dieplinger
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria
| | - Thomas Mueller
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy.
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Jamé S, Kutyifa V, Polonsky B, McNitt S, Al-Ahmad A, Moss AJ, Zareba W, Wang PJ. Predictive value of device-derived activity level for short-term outcomes in MADIT-CRT. Heart Rhythm 2017; 14:1081-1086. [DOI: 10.1016/j.hrthm.2017.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 10/19/2022]
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Zile MR, Bennett TD, El Hajj S, Kueffer FJ, Baicu CF, Abraham WT, Bourge RC, Warner Stevenson L. Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor: Relationship to Mortality in Patients With Chronic Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003594. [PMID: 28062538 DOI: 10.1161/circheartfailure.116.003594] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this analysis was to examine whether implantable hemodynamic monitor-derived baseline estimated pulmonary artery diastolic pressure (ePAD) and change from baseline ePAD were independent predictors of all-cause mortality in patients with chronic heart failure. METHODS AND RESULTS Retrospective analysis used data from 3 studies (n=790 patients; 216 deaths). Baseline ePAD was related to mortality using a multivariable model including baseline and demographic data. Changes in ePAD defined as change from baseline to 6 months and from baseline to 14 days before death or exit from study were related to subsequent mortality, and analysis was adjusted for baseline ePAD. Area under the pressure versus time curve during 180 days before death or exit from study was related to mortality. Baseline ePAD, independent of other covariates, was a significant predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.09; P<0.0001). Change in ePAD was an independent predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.100; P=0.0008). Increased ePAD of 3, 4, or 5 mm Hg from baseline to 6 months was associated with increased mortality risk of 23.8%, 32.9%, or 42.8%. Change in ePAD from baseline to 14 days before death or exit from study was higher in patients who died (3.0±8 versus 1.7±10 mm Hg; P=0.003). Area under the pressure versus time curve in the final 180 days before death or exit from study was higher in patients who died versus those alive at end of study (185±668 versus 17±482 mm Hg.days; P=0.006). CONCLUSIONS Implantable hemodynamic monitor-derived baseline ePAD and change from baseline ePAD were independent predictors of mortality in chronic heart failure patients.
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Affiliation(s)
- Michael R Zile
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.).
| | - Tom D Bennett
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Stephanie El Hajj
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Fred J Kueffer
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Catalin F Baicu
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - William T Abraham
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Robert C Bourge
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
| | - Lynne Warner Stevenson
- From the RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z., S.E.H., C.F.B.); Medtronic, Inc, Minneapolis, MN (T.D.B., F.J.K.); The Ohio State University, Columbus (W.T.A.), University of Alabama at Birmingham (R.C.B.); and Brigham and Women's Hospital, Boston, MA (L.S.)
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13
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Cuba Gyllensten I, Crundall-Goode A, Aarts RM, Goode KM. Simulated case management of home telemonitoring to assess the impact of different alert algorithms on work-load and clinical decisions. BMC Med Inform Decis Mak 2017; 17:11. [PMID: 28095849 PMCID: PMC5240411 DOI: 10.1186/s12911-016-0398-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/09/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Home telemonitoring (HTM) of chronic heart failure (HF) promises to improve care by timely indications when a patient's condition is worsening. Simple rules of sudden weight change have been demonstrated to generate many alerts with poor sensitivity. Trend alert algorithms and bio-impedance (a more sensitive marker of fluid change), should produce fewer false alerts and reduce workload. However, comparisons between such approaches on the decisions made and the time spent reviewing alerts has not been studied. METHODS Using HTM data from an observational trial of 91 HF patients, a simulated telemonitoring station was created and used to present virtual caseloads to clinicians experienced with HF HTM systems. Clinicians were randomised to either a simple (i.e. an increase of 2 kg in the past 3 days) or advanced alert method (either a moving average weight algorithm or bio-impedance cumulative sum algorithm). RESULTS In total 16 clinicians reviewed the caseloads, 8 randomised to a simple alert method and 8 to the advanced alert methods. Total time to review the caseloads was lower in the advanced arms than the simple arm (80 ± 42 vs. 149 ± 82 min) but agreements on actions between clinicians were low (Fleiss kappa 0.33 and 0.31) and despite having high sensitivity many alerts in the bio-impedance arm were not considered to need further action. CONCLUSION Advanced alerting algorithms with higher specificity are likely to reduce the time spent by clinicians and increase the percentage of time spent on changes rated as most meaningful. Work is needed to present bio-impedance alerts in a manner which is intuitive for clinicians.
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Affiliation(s)
- Illapha Cuba Gyllensten
- Personal Health Solutions, Philips Research, p.030, High Tech Campus 34, Eindhoven, 5656AE Netherlands
- Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Amanda Crundall-Goode
- Dept. of Nursing, Faculty of Health & Social Care, University of Hull, Kingston-Upon-Hull, UK
| | - Ronald M. Aarts
- Personal Health Solutions, Philips Research, p.030, High Tech Campus 34, Eindhoven, 5656AE Netherlands
- Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Kevin M. Goode
- Dept. of Health Professional Studies, Faculty of Health & Social Care, University of Hull, Kingston-Upon-Hull, UK
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14
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Shah SJ, Kitzman DW, Borlaug BA, van Heerebeek L, Zile MR, Kass DA, Paulus WJ. Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction: A Multiorgan Roadmap. Circulation 2016; 134:73-90. [PMID: 27358439 DOI: 10.1161/circulationaha.116.021884] [Citation(s) in RCA: 657] [Impact Index Per Article: 82.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (EF; HFpEF) accounts for 50% of HF cases, and its prevalence relative to HF with reduced EF continues to rise. In contrast to HF with reduced EF, large trials testing neurohumoral inhibition in HFpEF failed to reach a positive outcome. This failure was recently attributed to distinct systemic and myocardial signaling in HFpEF and to diversity of HFpEF phenotypes. In this review, an HFpEF treatment strategy is proposed that addresses HFpEF-specific signaling and phenotypic diversity. In HFpEF, extracardiac comorbidities such as metabolic risk, arterial hypertension, and renal insufficiency drive left ventricular remodeling and dysfunction through systemic inflammation and coronary microvascular endothelial dysfunction. The latter affects left ventricular diastolic dysfunction through macrophage infiltration, resulting in interstitial fibrosis, and through altered paracrine signaling to cardiomyocytes, which become hypertrophied and stiff because of low nitric oxide and cyclic guanosine monophosphate. Systemic inflammation also affects other organs such as lungs, skeletal muscle, and kidneys, leading, respectively, to pulmonary hypertension, muscle weakness, and sodium retention. Individual steps of these signaling cascades can be targeted by specific interventions: metabolic risk by caloric restriction, systemic inflammation by statins, pulmonary hypertension by phosphodiesterase 5 inhibitors, muscle weakness by exercise training, sodium retention by diuretics and monitoring devices, myocardial nitric oxide bioavailability by inorganic nitrate-nitrite, myocardial cyclic guanosine monophosphate content by neprilysin or phosphodiesterase 9 inhibition, and myocardial fibrosis by spironolactone. Because of phenotypic diversity in HFpEF, personalized therapeutic strategies are proposed, which are configured in a matrix with HFpEF presentations in the abscissa and HFpEF predispositions in the ordinate.
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Affiliation(s)
- Sanjiv J Shah
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Dalane W Kitzman
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Barry A Borlaug
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Loek van Heerebeek
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Michael R Zile
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - David A Kass
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Walter J Paulus
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.).
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15
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Cuba-Gyllensten I, Gastelurrutia P, Bonomi AG, Riistama J, Bayes-Genis A, Aarts RM. A method to adapt thoracic impedance based on chest geometry and composition to assess congestion in heart failure patients. Med Eng Phys 2016; 38:S1350-4533(16)30021-2. [PMID: 27150235 DOI: 10.1016/j.medengphy.2016.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 01/18/2016] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Abstract
Multi-frequency trans-thoracic bioimpedance (TTI) could be used to track fluid changes and congestion of the lungs, however, patient specific characteristics may impact the measurements. We investigated the effects of thoracic geometry and composition on measurements of TTI and developed an equation to calculate a personalized fluid index. Simulations of TTI measurements for varying levels of chest circumference, fat and muscle proportion were used to derive parameters for a model predicting expected values of TTI. This model was then adapted to measurements from a control group of 36 healthy volunteers to predict TTI and lung fluids (fluid index). Twenty heart failure (HF) patients treated for acute HF were then used to compare the changes in the personalized fluid index to symptoms of HF and predicted TTI to measurements at hospital discharge. All the derived body characteristics affected the TTI measurements in healthy volunteers and together the model predicted the measured TTI with 8.9% mean absolute error. In HF patients the estimated TTI correlated well with the discharged TTI (r=0.73,p <0.001) and the personalized fluid index followed changes in symptom levels during treatment. However, 37% (n=7) of the patients were discharged well below the model expected value. Accounting for chest geometry and composition might help in interpreting TTI measurements.
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Affiliation(s)
- Illapha Cuba-Gyllensten
- Department of Chronic Disease Management, Philips Research, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Paloma Gastelurrutia
- ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Alberto G Bonomi
- Department of Chronic Disease Management, Philips Research, Eindhoven, the Netherlands
| | - Jarno Riistama
- Department of Chronic Disease Management, Philips Research, Eindhoven, the Netherlands
| | - Antoni Bayes-Genis
- ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ronald M Aarts
- Department of Chronic Disease Management, Philips Research, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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16
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Small RS, Tang WHW. Assessing Impedance in Heart Failure: From Device Diagnostics to Population Health Opportunities? Circ Heart Fail 2015; 9:e002761. [PMID: 26699395 DOI: 10.1161/circheartfailure.115.002761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Roy S Small
- From The Heart Group of Lancaster General Hospital, Lancaster, PA (R.S.S.); and Heart and Vascular Institute, Cleveland Clinic, OH (W.H.W.T.)
| | - W H Wilson Tang
- From The Heart Group of Lancaster General Hospital, Lancaster, PA (R.S.S.); and Heart and Vascular Institute, Cleveland Clinic, OH (W.H.W.T.)
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