Hemodynamic factors associated with acute XXXX : part 2--use in automated detection.

@entity1 @entity551 @entity712 @entity1009
BACKGROUND: The purpose of this study was to develop an automated surveillance system, using pressure-based hemodynamic factors that would detect which @entity1 were making the transition from compensated to @entity712 before they developed worsening symptoms and required acute medical  care. METHODS AND RESULTS: Intracardiac pressures in 274 @entity1 with @entity712 were measured using an implantable hemodynamic monitor (IHM) and were analyzed in a retrospective manner. An automated @entity551 ( @entity551 ) algorithm was developed using the cumulative sum method. The performance  characteristics of the @entity551 algorithm were defined in all @entity1 who developed a @entity712 -related event (HFRE); @entity1 without HFRE served as controls. Optimal @entity551 threshold values were chosen using a receiver operator curve analysis. Each of the pressures measured with the IHM were evaluated using the @entity551 analysis. All had sensitivities >= 80% and false-positive rates <4.7/ @entity1 -year; however, estimated pulmonary artery diastolic pressure (ePAD) had the best performance. An ePAD based on the optimized @entity551 threshold of 6.0 yielded a sensitivity of 83% and a false-positive rate of 4.1/ @entity1 -year for detecting @entity1 making the transition from compensated to @entity712 . These  performance characteristics were not significantly different for @entity1 with an ejection fraction > vs. <50%, estimated glomerular filtration rate > vs. <60 mL/ @entity1009 .73 m(2), or age > vs. <60 years. CONCLUSIONS: The automated @entity551 algorithm had high sensitivity and acceptable false-positive rates in detecting the development of @entity712 before the @entity1 developed worsening symptoms and required acute medical care. These data support the development of a prospective study to examine the utility of adding an automated @entity551 algorithm to IHM-based management strategies to prevent @entity712 .
