Reduced LV Pacing Percentages are Associated with Progressively Worse Measures of Heart Failure Physiology in CRT Patients

Abstract

Introduction HeartLogic, an implanted device based heart failure (HF) index and alert algorithm, aggregates physiologic trends associated with multiple aspects of heart failure status (e.g. heart sounds, heart rate, thoracic impedance, respiration rate, tidal volume, and activity). HeartLogic alerts were recently shown to detect HF events with 70% sensitivity and 34 days of advanced warning, and identify patients with 10-fold increased risk of worsening HF. Separately, lower LV pacing percentages have been associated with significantly worse survival in a cohort of >35000 remotely monitored CRT patients. This current analysis investigated whether a deteriorating HF status would be suggested by continuous measures of heart failure pathophysiology at lower pacing percentages. Methods Sensor data was obtained from 900 ambulatory HF patients with implanted CRT devices for up to a year in the MultiSENSE study. The percent of heart beats with LV pacing was assessed for periods (median = 7.3 days; IQR: 6.4 - 43.4) between data downloads (median = 55 periods/patient; IQR: 10 - 68) and compared to the sensor data. Results Worsening sensor trends were found with progressively lower pacing percentages (See Figure). While IN the HeartLogic alert state (above an Index of 16) the odds of optimal LV pacing (>98%) were less than when OUT of the HeartLogic alert state for a given subject (OR: 0.655; 95% CI: 0.626 - 0.686; p Conclusion Lower LV pacing percent is associated with multiple markers of worsening HF, and patients in HeartLogic alert are more likely to have sub-optimal LV pacing. The impact of HeartLogic alert driven interventions on the percent biventricular pacing and outcomes is being assessed in the MANAGE-HF clinical trial.