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 –

Objective: Evaluate the prognostic implications of N-terminal Pro-B-type Natriuretic Peptide measurements in ambulatory patients with continuous flow left ventricle assist devices (CFLVAD). Methods: We performed a retrospective study of consecutive patients that had an LVAD implantation at our institution and were discharged from their index hospitalization. Results: Between January 31 st , 2006 and August 21 st , 2019, 139 patients received a continuous flow left ventricle assist device implant at our institution and survived beyond their index hospitalization. 127 patients (56.2±12.5 years, 78.7 % male) had NT pro BNP measured at 1- and 3-months post discharge in ambulatory settings. The median (IQR) NT-pro BNP levels were 1661 pg/mL (921-2558 pg/mL) at 1 month and 1094 pg/mL (673-2089 pg/mL) at 3 months post discharge. After a median follow up of 17 months, a total of 53 (41.7%) incidents event occurred. Of these, 37 (69.8%) were heart failure hospitalizations and 16 (30.2%) were deaths. For each 1000-unit increase in NT-pro BNP level at 3 months, there was a 17% increase in the risk of heart failure hospitalization or death (HR=1.17, 95% CI=1.04-1.32, p=0.007)). Also, for each 1000-unit decline in NT-pro BNP level between the 1 st and 3 rd months, there was an 11% decrease in the risk of heart failure hospitalization or death (HR=0.89, 95% CI=0.77-0.98, p=0.04). Conclusion: In ambulatory patients with CFLVAD, increase in NT pro BNP value from one to three months is associated with a significantly increased risk of heart failure hospitalization and death.

Download Full-text

An improved algorithm calculated from intrathoracic impedance can precisely diagnose preclinical heart failure events: Sub-analysis of a multicenter MOMOTARO (Monitoring and Management of OptiVol Alert to Reduce Heart Failure Hospitalization) trial study

Journal of Cardiology ◽

10.1016/j.jjcc.2017.05.004 ◽

2017 ◽

Vol 70 (5) ◽

pp. 425-431 ◽

Cited By ~ 1

Author(s):

Akihito Miyoshi ◽

Nobuhiro Nishii ◽

Motoki Kubo ◽

Yoji Okamoto ◽

Satoki Fujii ◽

...

Keyword(s):

Heart Failure ◽

Heart Failure Hospitalization ◽

Intrathoracic Impedance ◽

Improved Algorithm

Download Full-text

Only Large Reductions in Concentrations of Natriuretic Peptides (BNP and NT-proBNP) Are Associated with Improved Outcome in Ambulatory Patients with Chronic Heart Failure

Clinical Chemistry ◽

10.1373/clinchem.2008.108928 ◽

2009 ◽

Vol 55 (1) ◽

pp. 78-84 ◽

Cited By ~ 27

Author(s):

Wayne L Miller ◽

Karen A Hartman ◽

Diane E Grill ◽

John C Burnett ◽

Allan S Jaffe

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Natriuretic Peptide ◽

Natriuretic Peptides ◽

Heart Association ◽

Class Iii ◽

Heart Failure Hospitalization ◽

Risk Of Death ◽

Increased Risk ◽

Reduced Risk

Abstract Background: Concentrations of B-type natriuretic peptides (BNPs), including N-terminal pro-B-type natriuretic peptide (NT-proBNP), can be used to estimate prognosis in chronic heart failure. Large biologic variability, however, limits the usefulness of serial measurements in individual patients. As a result, the magnitude of change in peptide concentrations that is clinically meaningful remains to be established. Methods: We studied 172 New York Heart Association class III–IV outpatients. Primary endpoints were death/transplantation or heart failure hospitalization. The magnitude of peptide changes was categorized as no change (<20% increase or decrease from enrollment), ≥20% to ≤80% increase or decrease; and >80% increase or decrease. Changes were also assessed using cutpoints (500 ng/L for BNP and 1000 ng/L for NT-proBNP). Results: Fifty-two patients died or received transplants during the course of the study. Risk reduction for heart failure hospitalization was demonstrated only for BNP decreases of >80% from enrollment [hazard ratio (HR) 0.318, P = 0.0315]. BNP increases from less than to more than the prespecified cutpoint of 500 ng/L were associated with increased mortality risk (HR 2.101, P = 0.0069), whereas decreases from more than to less than the cutpoint did not reduce risk. NT-proBNP decreases from more than to less than the cutpoint of 1000 ng/L were associated with reduced risk of death/transplantation (HR 0.119, P = 0.0354). Conclusions: BNP increases from less than to more than the cutpoint were associated with increased risk of events, whereas further increases did not add to risk. In contrast, only substantial natriuretic peptide decreases (>80%) reduced risk. These data suggest that only robust decreases in natriuretic peptide concentrations should be targeted to reduce mortality and heart failure-related hospitalizations.

Download Full-text

Natriuretic Peptide Testing for Predicting Adverse Events Following Heart Failure Hospitalization

Congestive Heart Failure ◽

10.1111/j.1751-7133.2012.00306.x ◽

2012 ◽

Vol 18 ◽

pp. S9-S13 ◽

Cited By ~ 19

Author(s):

James L. Januzzi ◽

Alan S. Maisel ◽

Marc Silver ◽

Yang Xue ◽

Christopher DeFilippi

Keyword(s):

Heart Failure ◽

Adverse Events ◽

Natriuretic Peptide ◽

Heart Failure Hospitalization

Download Full-text

Prognostic value of brain natriuretic peptide vs history of heart failure hospitalization in a large real‐world population

Clinical Cardiology ◽

10.1002/clc.23468 ◽

2020 ◽

Vol 43 (12) ◽

pp. 1501-1510

Author(s):

Michael R. Zile ◽

Akshay S. Desai ◽

Rahul Agarwal ◽

Rupinder Bharmi ◽

Nirav Dalal ◽

...

Keyword(s):

Heart Failure ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Real World ◽

Prognostic Value ◽

World Population ◽

Heart Failure Hospitalization ◽

History Of

Download Full-text

Monitoring of heart failure: comparison of left atrial pressure with intrathoracic impedance and natriuretic peptide measurements in an experimental model of ovine heart failure

Clinical Science ◽

10.1042/cs20100388 ◽

2010 ◽

Vol 120 (5) ◽

pp. 207-217 ◽

Cited By ~ 9

Author(s):

Miriam T. Rademaker ◽

Christopher J. Charles ◽

Iain C. Melton ◽

A. Mark Richards ◽

Christopher M. Frampton ◽

...

Keyword(s):

Heart Failure ◽

Natriuretic Peptide ◽

Natriuretic Peptides ◽

Left Atrial ◽

Left Ventricular ◽

Atrial Pressure ◽

Left Atrial Pressure ◽

Cardiac Resynchronization ◽

Delayed Response ◽

Intrathoracic Impedance

Monitoring of HF (heart failure) with intracardiac pressure, intrathoracic impedance and/or natriuretic peptide levels has been advocated. We aimed to investigate possible differences in the response patterns of each of these monitoring modalities during HF decompensation that may have an impact on the potential for early therapeutic intervention. Six sheep were implanted with a LAP (left atrial pressure) sensor and a CRT-D (cardiac resynchronization therapy defibrillator) capable of monitoring impedance along six lead configuration vectors. An estimate of ALAP (LAP from admittance) was determined by linear regression. HF was induced by rapid ventricular pacing at 180 and 220 bpm (beats/min) for a week each, followed by a third week with daily pacing suspensions for increasing durations (1–5 h). Incremental pacing induced progressively severe HF reflected in increases in LAP (5.9 ± 0.4 to 24.5 ± 1.6 mmHg) and plasma atrial (20 ± 3 to 197 ± 36 pmol/l) and B-type natriuretic peptide (3.7 ± 0.7 to 32.7 ± 5.4 pmol/l) (all P<0.001) levels. All impedance vectors decreased in proportion to HF severity (all P<0.001), with the LVring (left ventricular)-case vector correlating best with LAP (r2=0.63, P<0.001). Natriuretic peptides closely paralleled rapid acute changes in LAP during alterations in pacing (P<0.001), whereas impedance changes were delayed relative to LAP. ALAP exhibited good agreement with LAP. In summary, impedance measured with an LV lead correlates significantly with changes in LAP, but exhibits a delayed response to acute alterations. Natriuretic peptides respond rapidly to acute LAP changes. Direct LAP, impedance and natriuretic peptide measurements all show promise as early indicators of worsening HF. ALAP provides an estimate of LAP that may be clinically useful.

Download Full-text