The multisensor HeartLogic algorithm for heart failure monitoring: the future is already here?

Mar 28, 2019 Cardiotool Novità Fibrillazione Atriale Commenti disabilitati su The multisensor HeartLogic algorithm for heart failure monitoring: the future is already here?

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L. Belfioretti M.D.¹;L. Cipolletta M.D.¹; A. Capucci M.D.¹

¹ Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, “Ospedali Riuniti”, Via Conca, 71, 60126, Ancona, Italy

AIMS: Nowadays device therapy represents a mainstay in the heart failure (HF) treatment improving the outcome of selected HF patients. The development of cardiac resynchronisation therapy and defibrillator (CRT-Ds)devices, has allowed to elaborate multiparametric algorithm for remote monitoring in order to prevent HF decompensation. We report our experience using Heart Logic index (HL index) which results from a combination of data (heart and respiratory rate, heart sounds, thoracic impedance, and patient activity) detected by the CRT-D. TheHL index has been shown to be sensitive and timely predictor of impending HF decompensation.

Methods and Results:We enrolled 23 patients with HF, 15 men and 8 women, (mean age71,8 years).15 patients suffered from a non-ischemic cardiomyopathy, 4 ischemic cardiomyopathy, 2 valvular heart disease and 2 had a congenitally corrected transposition of the great arteries with HF. All patients received a HeartLogic-enabled CRT-D device (RESONATE, Boston Scientific). The average ejection fraction at the implant was 29% calculated using Simpson biplane mode. All patients were daily monitored with remote controlof device parameters, monthly telephone calls and medical examination at the implant, after 6 and 12 months. After a follow-up of12 months the HL index crossed the cut-off (set by default to 16, according to the results of MULTISENSE study) 14 times in 8 patients. These alerts preceded 1 hospitalisation for non cardiovascular causes, 1 for severe symptomatic aortic stenosis which required trans aortic valve implantation and 6 unplanned in-office visits. In 4 of 6 unplanned visits, the clinical examination revealed signs and symptoms of HF (ankles swelling and dyspnea), worsening of NYHA class and poor compliance with diuretic therapy, while in the other 2 visits, at the device interrogation, respectively were documented a ventricular tachycardia and an atrial flutter. All 6 unplanned in-office follow-up required an optimisation in medical therapy.

Conclusions: This retrospective analysis confirms that the HL index is sensitive and reliable in recognising early phase of HF decompensation. Moreover, it is decisive for early arrhythmia detection that could provoke HF decompensation. The rapid optimisation of medical therapies could  have a role in the prevention of worsening HF and in avoiding the consequent hospitalisation.

 

 

 

 

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