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Long-term monitoring of respiratory rate in patients with heart failure: the Multiparametric Heart Failure Evaluation in Implantable Cardioverter-Defibrillator Patients (MULTITUDE-HF) study

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Monitoring respiratory rate (RR) is recommended at the time of hospital presentation for acute decompensation in heart failure (HF). Device-based continuous monitoring of RR may be helpful for diagnostic and prognostic stratification after implantable cardioverter-defibrillator (ICD) implantation. This study was undertaken to analyze short- and long-term changes in ICD-measured RR and to relate RR with the patient’s clinical status and the occurrence of HF events.

Methods

One hundred twenty-four consecutive HF patients who received ICD endowed with this diagnostic capability (Boston Scientific Inc., Natick, MA, USA) were prospectively enrolled. Patients were followed up for 12 months.

Results

At the baseline, the proportion of New York Heart Association (NYHA) class III–IV was higher among patients with daily maximum RR >27 breaths/min (third tertile) than those with <24 breaths/min (first tertile) (43 vs. 23 %, p < 0.05). Moreover, the ejection fraction was lower (27 ± 7 vs. 34 ± 8 %, p < 0.05). In patients with HF hospitalizations (33 events) and urgent visits for HF (15 events), the weekly average of RR calculated over the 7 days preceding hospital accesses did not differ from values recorded at the baseline and before scheduled follow-up visits. However, the weekly variation in RR (i.e., the difference between maximum and minimum values collected over the week) was significantly higher prior to hospitalization (p < 0.05). A weekly variation >3 breaths/min in maximum RR predicted an impending hospital admission for HF with sensitivity of 73 % and specificity of 57 %.

Conclusions

In this study, elevated values of ICD-monitored RR identified patients with worse functional status and lower systolic function. The weekly variation in RR increased before HF exacerbation. This monitoring technology may represent a useful tool in the clinical management of patients with HF.

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Abbreviations

CRT-D:

Cardiac resynchronization therapy defibrillators

ICD:

Implantable cardioverter-defibrillators

HF:

Heart failure

RR:

Respiratory rate

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Funding sources

None.

Conflict of interest

M. Lovecchio, U. Riva, and S. Valsecchi are employees of Boston Scientific. GB. Forleo, A. Natale, and L. Santini received speaker honoraria from Boston Scientific. The remaining authors have no disclosures.

Author information

Authors and Affiliations

  1. Cardiology, University of Tor Vergata, Viale Oxford, 81., 00133, Rome, Italy

    Giovanni B. Forleo, Luca Santini, Valentina Ribatti & Francesco Romeo

  2. Ospedale Belcolle, Viterbo, Italy

    Massimiliano Campoli & Mario Malavasi

  3. Ospedale SS. Trinità, Sora, Frosinone, Italy

    Alberto Scaccia

  4. Ospedale F. Spaziani, Frosinone, Italy

    Maurizio Menichelli

  5. Boston Scientific, Milan, Italy

    Umberto Riva, Mariolina Lovecchio & Sergio Valsecchi

  6. Ospedale S. Eugenio, Rome, Italy

    Filippo Lamberti

  7. Ospedale S. Maria, Terni, Italy

    Giovanni Carreras

  8. Ospedale San Camillo de Lellis, Rieti, Italy

    Serafino Orazi

  9. Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA

    Luigi Di Biase

  10. Department of Cardiology, University of Foggia, Foggia, Italy

    Luigi Di Biase

  11. Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX, USA

    Luigi Di Biase & Andrea Natale

Authors
  1. Giovanni B. Forleo
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  2. Luca Santini
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  3. Massimiliano Campoli
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  4. Mario Malavasi
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  5. Alberto Scaccia
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  6. Maurizio Menichelli
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  7. Umberto Riva
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  8. Filippo Lamberti
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  9. Giovanni Carreras
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  10. Serafino Orazi
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  11. Valentina Ribatti
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  12. Luigi Di Biase
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  13. Mariolina Lovecchio
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  14. Andrea Natale
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  15. Sergio Valsecchi
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  16. Francesco Romeo
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Corresponding author

Correspondence to Giovanni B. Forleo.

Additional information

Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01501331

Appendix

Appendix

The following Italian institutions and investigators participated in the study—Policllinico Tor Vergata, Rome: GB. Forleo, G. Magliano, G. Panattoni, V. Ribatti, D. Sergi, L. Santini, and F. Romeo; Ospedale Belcolle, Viterbo: M. Campoli, M. Malavasi, and M. Sassara; Ospedale SS. Trinità, Sora: A. Scaccia; Ospedale F. Spaziani, Frosinone: L. Carbonardi and M. Menichelli; Ospedale S. Eugenio, Roma: F. Lamberti; Ospedale Santa Maria, Terni: C. Marini and G. Carreras; and Ospedale San Camillo de Lellis, Rieti: S. Orazi and A. Menè.

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Forleo, G.B., Santini, L., Campoli, M. et al. Long-term monitoring of respiratory rate in patients with heart failure: the Multiparametric Heart Failure Evaluation in Implantable Cardioverter-Defibrillator Patients (MULTITUDE-HF) study. J Interv Card Electrophysiol 43, 135–144 (2015). https://doi.org/10.1007/s10840-015-0007-3

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  • DOI: https://doi.org/10.1007/s10840-015-0007-3

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