Evaluation of multisensor data for diagnosing clinical deterioration in patients with heart failure and implantable cardioverter-defibrillators

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Aim . To evaluate the potential of multisensor monitoring by an implantable cardioverter-defibrillator (ICD) for detecting clinical deterioration of heart failure (HF) by comparing sensor data with laboratory, functional, and clinical parameters. Material and methods . This prospective study included 56 patients with NYHA class II-III HF and a left ventricular ejection fraction ≤35% who were implanted with multisensor ICDs. Follow-up visits were conducted at 6 and 12 months, including the 6-minute walk test (6MWT), echocardiography, N-terminal pro-brain natriuretic peptide (NT-proBNP) level assessment, and device interrogation with sensor data analysis. Based on the 6-month visit results, patients were divided into groups with and without clinical HF deterioration. Deterioration criteria included at least one of the following: a decrease in 6MWT distance, edema worsening, or an increase in NT-proBNP levels by >30% from baseline, combined with a HeartLogic index exceeding the threshold >16. Correlation analysis was used to assess associations between selected multisensor monitoring parameters and clinical/laboratory indicators in the entire cohort. Additionally, an exploratory subgroup analysis was performed for patients with clinical HF deterioration. Results . Heart failure (HF) clinical worsening after 6 months was observed in 22 (39,3%) patients and was associated with unfavorable changes of multisensor parameters compared to patients without HF progression, an increase in NT-proBNP levels (2182 vs 847 pg/mL; p<0,001), a decrease in left ventricular ejection fraction (29 vs 31%; p<0,001), and a reduction in the 6-minute walk test (6MWT) distance (277 vs 355 m; p=0,003). These patients exhibited higher amplitudes of the third heart sound (S3) measured by the ICD, higher respiratory rates, and higher nocturnal heart rates, as well as decreased transthoracic impedance and heart rate variability (p for all <0,01). In the entire cohort, significant inverse correlations were found between respiratory rate and 6MWT distance (r=-0,66; p<0,001), and between transthoracic impedance and NT-proBNP levels (r=-0,58; p<0,001). In the group of patients with clinical HF worsening, these associations were more pronounced. Following therapy adjustment, NT-proBNP levels decreased (p<0,01). Conclusion . Multisensor ICD monitoring is associated with clinical, laboratory, and functional signs of HF worsening. Unfavorable dynamics of individual device-detected parameters were accompanied by higher NT-proBNP levels, reduced 6MWT distance, and less favorable echocardiographic indices, which confirms the potential of multisensor monitoring for proactive and personalized patient management and warrants further investigation in larger prospective studies.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.