基于CorVue算法的经胸阻抗监测报警在慢性心力衰竭患者中的应用

目的 评估CorVue系统报警对识别患者心功能变化和心力衰竭(心衰)事件的有效性及诊断价值。 方法 选择2015年1月—2018年5月于中国科学技术大学附属第一医院(安徽省立医院)植入带有经胸阻抗监测功能CRT-D的慢性心衰患者,收集患者年龄、性别、心衰病因、NYHA心功能分级、血液生化指标、治疗药物等基线资料。术后1、3、6、12个月于起搏器门诊进行常规随访,发生装置报警或心功能恶化时于心衰门诊或急诊进行非预期随访。回顾性分析患者基线资料及随访资料,根据装置报警30 d内有无心衰事件发生定义有效报警与无效报警,计算CorVue系统报警对心衰事件的预测价值,观察报警后的NT-proBNP水平变化。 结果 研究共纳入51例心衰患者,平均年龄(63±8)岁,女性占35.29%。12个月随访期间共发生73次CorVue系统报警,23次心衰事件,CorVue系统报警对心衰事件预测的敏感性为35%,特异性为30%,阳性预测值为11%,阴性预测值为65%。71%的装置报警伴有NT-ProBNP水平升高,报警后NT-ProBNP水平较基线1 623(1 160,1 902)]增加32%(P=0.001),其中有效报警组较基线1 734(1 276,1 844)]增加109%(P=0.012),无效报警组较基线1 623(1 049,1 902)]增加22%(P=0.029)。 结论 本研究发现CorVue系统报警的价值在于反映患者潜在的心功能变化,而不是单纯预警心衰发作。 

Application of intrathoracic impedance monitoring and alarm based on CorVue algorithm in patients with chronic heart failure

Objective To evaluate the effectiveness and diagnostic value of CorVue system alarm in identifying cardiac function changes and heart failure events of patients. Methods Patients with chronic heart failure with transthoracic impedance monitoring function CRT-D were enrolled in our hospital from January 2015 to May 2018. Baseline data such as age, gender, heart failure etiology, NYHA heart function class, blood biochemical indicators and therapeutic drugs were collected. At 1, 3, 6 and 12 months after surgery, routine follow-up was performed in the pacemaker clinic, and unexpected follow-up was performed in the heart failure clinic or emergency department when device alarm or cardiac function deterioration occurred. The baseline data and follow-up data of the patients were analyzed retrospectively. The effective alarm and invalid alarm were defined according to whether there was a heart failure event within 30 days of the device alarm. The predicted value of the CorVue system alarm for heart failure events was calculated, and the NT-proBNP level after the alarm was observed. Results Total 51 patients with heart failure were included in the study, with an average age of(63±8) years and women with 35.29%. A total of 73 CorVue system alarms and 23 heart failure events occurred during the 12-month follow-up. Sensitivity of CorVue alarms was 35%, specificity was 30%, positive predictive value of 11% and negative predictive value of 65%. 71% of the alarms were accompanied by an increase in NT-ProBNP level1 623(1 160,1 902)]. After the alarm, the level of NT-ProBNP increased 32%1 734(1 276,1 844), P=0.001]. The NT-ProBNP levels of the effective alarm group and the invalid alarm group increased by 109%(P=0.012) and 22%(P=0.029) respectively1 623(1 049,1 902)]. Conclusion The value of CorVue alarm lies in reflecting the potential changes of cardiac function, rather than simply predicting heart failure events.