Abstract 17112: Continuous Preload Measurement to Modulate Treatment of Heart Failure
IntroductionIn managing heart failure, increased physician intervention and medication-adjustment in response to changes in hemodynamic status has been proven to reduce morbidity. In practice, this can be accomplished through the optimization of pulmonary artery pressure (PAP) range using a dedicate...
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| Published in: | Circulation (New York, N.Y.) Vol. 134; no. Suppl_1 Suppl 1; p. A17112 |
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| Main Authors: | , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
by the American College of Cardiology Foundation and the American Heart Association, Inc
11-11-2016
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| Online Access: | Get full text |
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| Summary: | IntroductionIn managing heart failure, increased physician intervention and medication-adjustment in response to changes in hemodynamic status has been proven to reduce morbidity. In practice, this can be accomplished through the optimization of pulmonary artery pressure (PAP) range using a dedicated, unpowered implant/reader combination. However, there is a large population of patients with already implanted and powered devices (ICDs & CRT-Ds), most of whom have appreciable risk. These patients would benefit from technology that enables their existing ICDs and leads to make hemodynamic measurements of preload.HypothesisA repeatable measurement of preload (LV EDV) can be made using a single-coil defibrillator lead with high agreement to a volume standard such as 3D Trans-Thoracic Echo (TTE).MethodsRECHARGE is a first-in-human trial performed in N=21 patients to determine the agreement between 3D TTE and RV lead determination of EDV. Volume was modulated by overdrive pacing at +10 and +50 bpm above baseline heart rate to reduce filling time, which reduces EDV. RV lead volume was calibrated to baseline 3D TTE on a patient-by-patient basis, to ensure that variation in lead scarring, placement, and brand would not affect the volume calculation.ResultsConcordance and Intraclass Correlation (CCC, ICC) between 3D TTE and RV lead EDV measurement was high (CCC=0.95, ICC=0.95). RV lead EDV had a mean within-subject Coefficient of Variation (wCV) of 2.4% (0% is perfect repeatability), while echo wCV was much higher at 9.9%. This implies that much of the agreement discrepancy in the study is due to high echo variability, and that RV lead volumes are more reliable than echo. Bland-Altman limits of agreement were LOA80% = (-17,% 17%).ConclusionsStatistics show excellent agreement between preload measurements made using a single coil RV lead and 3D TTE, implying that EDV could be measured with high repeatability in an ambulatory setting, without a dedicated implant. |
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| ISSN: | 0009-7322 1524-4539 |