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European Journal of Heart Failure 2007 9(6-7):716-722; doi:10.1016/j.ejheart.2007.03.005
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© 2007 European Society of Cardiology

Intrathoracic impedance monitoring to detect chronic heart failure deterioration: Relationship to changes in NT-proBNP

Lars Lüthjea,*, Dirk Vollmanna, Till Dreschera, Peter Schotta, Dieter Zenkerb, Gerd Hasenfuβa and Christina Unterberga

a Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
b Abteilung Thorax-Herz-Gefäβchirurgie, Georg-August-Universität, Göttingen, Germany

* Corresponding author. Tel: +49 551 39 9650; fax: +49 551 39 6293. E-mail address: larsluethje{at}med.uni-goettingen.de


  Abstract

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).

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

Methods and 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.).

Conclusion: 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.

Key Words: Cardiac resynchronisation therapy • Intrathoracic impedance monitoring • Chronic heart failure • NT-proBNP

Received September 1, 2006; Revised January 19, 2007; Accepted March 12, 2007


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