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. 2012 Sep;33(17):2189-96.
doi: 10.1093/eurheartj/ehs121. Epub 2012 Jun 7.

Threshold crossing of device-based intrathoracic impedance trends identifies relatively increased mortality risk

Wai Hong Wilson Tang  1 , Eduardo N Warman, James W Johnson, Roy S Small, James Thomas Heywood
Affiliations

Threshold crossing of device-based intrathoracic impedance trends identifies relatively increased mortality risk

Wai Hong Wilson Tang et al. Eur Heart J. 2012 Sep.

Abstract

Aims: Threshold crossings of impedance trends detected by implanted devices have been associated with clinically relevant heart failure events, but long-term prognosis of such events has not been demonstrated. The aim of this study is to examine the relationship between alterations in intrathoracic impedance and mortality risk in patients with implantable devices.

Methods and results: We reviewed remote monitoring data in the de-identified Medtronic CareLink(®) Discovery Link that captured intrathoracic impedance trends for >6 months. The initial 6 months of the cardiac and impedance trends were used as the observation period to create the patient groups and cross-referenced with the Social Security Death Index for mortality data. In our study cohort of 21 217 patients, 36% experienced impedance threshold crossing within the initial 6 months of monitoring (defined as the 'early threshold crossing' group). Patients with early threshold crossings demonstrated an increased risk of age- and gender-adjusted all-cause mortality [hazard ratio (HR) 2.15, 95% confidence interval (CI) 1.95-2.38, P< 0.0001]. Increased mortality risk remained significant when analysed in subgroups of patients without defibrillator shock (HR 2.10, 95% CI 1.90-2.34, P< 0.0001, n= 1621) or within those patients without device-detectable atrial fibrillation (AF) during the initial 6 months of monitoring (HR 2.09, 95% CI 1.86-2.34, P< 0.0001, n= 17 235). Both the number and the duration of early threshold crossings of impedance trends detectable by implanted devices were associated with increased mortality risk. Furthermore, the improvement of altered impedance trends portends more favourable prognosis.

Conclusions: Threshold crossing of impedance trends detectable by implanted devices is associated with relatively increased mortality risk even after adjusted for demographic, device-detected AF, or defibrillator shocks.

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Figures

Figure 1
Figure 1
Examples of intrathoracic impedance trends in patients with vs. without early threshold crossing.
Figure 2
Figure 2
The Kaplan–Meier survival analysis for all-cause mortality stratified by the presence or absence of early intrathoracic impedance threshold crossings.
Figure 3
Figure 3
The Kaplan–Meier survival analysis for all-cause mortality stratified by the time and the duration of early intrathoracic impedance threshold crossings and device characteristics (atrial fibrillation and defibrillator shocks).
Figure 4
Figure 4
Hazard ratios with an increasing number and duration of early threshold crossings compared with no early threshold crossings.
Figure 5
Figure 5
The Kaplan–Meier survival analysis for all-cause mortality stratified by the presence and absence of ‘Early’ (0–6 months) as well as ‘Late’ (6–12 months) intrathoracic impedance threshold crossing.
See this image and copyright information in PMC

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