Multisensor Remote Monitoring for Heart Failure Exacerbations in Patients with Left Ventricular Assist Devices

Abstract

Background Continuous flow left ventricular assist devices (cfLVADs) have improved outcomes for advanced Heart Failure (HF) patients. Recurrent HF continues to be a complication and clinical examination is limited by the nature of the LVAD therapy requiring better diagnostics to improve patient outcomes. Methods We describe a multisensory diagnostic in two LVAD patients. Results Two patients with end-stage HF supported with a HeartMate II and HeartMate III containing a multisensor diagnostic for HF (HeartLogic) presented to clinic with exercise intolerance. In both, exam revealed no elevation of venous pressure, lungs were clear and no heart sounds were appreciated above the normal LVAD hum. On right heart catheterization of patient A, RA pressure was 14 mmHg, PCWP 18 mmHg and CI 1.9 L/min/m2. LVAD speed was increased from 10,000 to 10,400 rpm. Similarly, elevated filling pressures were seen with patient B, who had LVAD speed increased as well. In both cases, S3 magnitude decreased following LVAD speed increase. Both patients later had outpatient alerts detected and diuretics were doubled until alert resolution. In each instance, the clinical events were associated with a HeartLogic alert, and remarkably, the S3 changed in manner consistent with the interventions that occurred although clinicians could not appreciate an S3. Conclusion These cases demonstrate that a multisensory HF diagnostic changes and alerts during clinically meaningful events that is useful in the management of LVAD patients.