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 –

Nobuhiro Nishii; Motoki Kubo; Yoji Okamoto; Satoki Fujii; Atsuyuki Watanabe; Yuko Toyama; Tadakatsu Yamada; Masayuki Doi; Hiroshi Morita; Hiroshi Ito; on behalf of MOMOTARO Investigators

doi:10.1253/circj.CJ-15-0076

Heart Failure

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 –

Nobuhiro Nishii, Motoki Kubo, Yoji Okamoto, Satoki Fujii, Atsuyuki Watanabe, Yuko Toyama, Tadakatsu Yamada, Masayuki Doi, Hiroshi Morita, Hiroshi Ito, on behalf of MOMOTARO Investigators

Author information

Nobuhiro Nishii
Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Motoki Kubo
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Yoji Okamoto
Department of Cardiovascular Medicine, Kurashiki Central Hospital
Satoki Fujii
Department of Cardiovascular Medicine, Kurashiki Central Hospital
Atsuyuki Watanabe
Department of Cardiovascular Medicine, Fukuyama City Hospital
Yuko Toyama
Department of Cardiovascular Medicine, Sakakibara Heart Institute of Okayama
Tadakatsu Yamada
Department of Cardiovascular Medicine, Ehime Prefectural Central Hospital
Masayuki Doi
Department of Cardiovascular Medicine, Kagawa Prefectural Central Hospital
Hiroshi Morita
Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Hiroshi Ito
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
on behalf of MOMOTARO Investigators

Keywords: Brain natriuretic peptide, Heart failure, Intrathoracic impedance, OptiVol alert, Remote monitoring

JOURNAL FREE ACCESS FULL-TEXT HTML

2015 Volume 79 Issue 6 Pages 1315-1322

DOI https://doi.org/10.1253/circj.CJ-15-0076

Editorial (79-6 pp. 1209-1210)

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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).Methods and 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). (Circ J 2015; 79: 1315–1322)

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