心力衰竭监测技术在心脏再同步治疗中的应用

心力衰竭监测技术在心脏再同步治疗中的应用内容摘要：

 Patient activity      Heart Rate Variability    Other Optivol Respiratory Rate sonR (needs special lead, not released yet) norm (Z) Extravascular Lung Water Index ELWI (ml/kg) norm (Z) Impedance Z (bipolar) LV End Diastolic Pressure LVEDP (mmHg) 肺部液体滁留与经胸阻抗相关性的动物试验 1 Becher J. et al. Europace (2020) 12, 731–740 2 Braunschweig et al. Europace (2020) 12, 731–740 Corr. Z vs. ELWI 目的：评估肺水肿诱发和恢复时经胸阻抗和直接测量胸腔内液体的相关性 方法： 20只 羊 ， 12例 NE诱发肺水肿 , 5例诱发肺水肿利尿恢复 , 3例对照 百多力 ICD测量 extravascular lung water (EVLW, PiCCO system)，intrathoracic impedance (coilcan)， LVEDP, MABP, Intrathoracic blood volume (ITBV) Yu C et al. Circulation 2020。 112:841848 Intrathoracic impedance monitoring in CHF: correlation with fluid status and feasibility of early warning preceding hospitalization (midhftrial) Parameters Nonhospitalized (n=23) Hospitalized (n=10) *P vs nonhospitalized. Age, y 77177。 11 79177。 4 Male, n (%) 14 (61) 7 (70) NYHA class, n (%) II 1 (4) 1 (10) III 21 (92) 9 (90) IV 1 (4) 0 Ejection fraction 50%, n (mean177。 SD, %) 6 (68177。 12) 2 (75177。 2) Ejection fraction ≤50%, n (mean 177。 SD, %) 17 (31177。 10) 8 (28177。 1) Cause of heart failure, n (%) Ischemic heart disease 4 (17) 7 (70)* Nonischemic (idiopathic, hypertensive, or valvular) 19 (83) 3 (30)* Atrial fibrillation, n (%) 13 (56) 4 (40) Medications at baseline, n (%) Aspirin 10 (43) 6 (60) Loop diuretics 23 (100) 10 (100) βBlockers 12 (52) 4 (40) ACE inhibitors 18 (78) 8 (80) Calcium antagonists 2 (9) 2 (20) Amiodarone 2 (9) 0 Digoxin 11 (48) 3 (30) Statins 4 (17) 4 (40) Yu C et al. Circulation 2020。 112:841848 Baseline Clinical Characteristics of 33 Patients With Implanted Devices Trend of average intrathoracic impedance for first 150 days after implantation for patients not hospitalized for heart failure during this period Yu C et al. Circulation 2020。 112:841848 Comparison of intrathoracic impedance at reference baseline and 1 day before admission for 24 hospitalizations resulting from worsening heart failure in 9 patients Yu C et al. Circulation 2020。 112:841848 Example from 1 patient. Yu C et al. Circulation 2020。 112:841848 Two occasions in which fluid index exceeded nominal threshold of 60 Ω d in same patient Yu C et al. Circulation 2020。 112:841848 Algorithm performance on validation data set Yu C et al. Circulation 2020。 112:841848 nominal threshold of 60 Ω d resulted in sensitivity of % and falsepositive rate of falsepositives per ptsyear of monitoring Conclusion Intrathoracic impedance is inversely correlated with PWCP and fluid balance and decreased before the onset of patient symptoms and before hospital admission for fluid overload. Regular monitoring of impedance may provide early warning of impending depensation and diagnostic information for titration of medication. The Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure (COMPASSHF study) To evaluate whether an implantable hemodynamic monitor (IHM) was safe and effective in reducing HFrelated events (HFRE) in CHF 70 pts with an EF or =50% (ie, DHF)， randomized to IHMguided care vs. control for 6 months The HFRE rate in DHF pts。