Background
N-terminal pro-B-type natriuretic peptide (NT-proBNP), a non-active fragment of the
prohormone proBNP, is produced by the heart and released in response to volume or
pressure overload. NT-proBNP has proven to be a valuable biomarker in the diagnosis
and prognosis of heart failure (HF), and NT-proBNP concentrations rise with worsening
HF. HeartLogic, a multi-sensor composite index and alert algorithm, aggregates multiple
physiologic trends associated with HF status, and proactively provides alerts for
worsening HF with high sensitivity and low alert burden.
Objective
To compare NT-proBNP concentrations during periods IN or OUT of an active HeartLogic
alert.
Methods
The MultiSENSE study enrolled 900 HF patients with an implanted COGNIS CRT-D, and
followed them up to 1 year. Device software was modified to permit collection of chronic
trends HeartLogic leveraged (heart sounds, heart rate, thoracic impedance, respiration
and activity). Clinicians were blinded to individual sensors and results of HeartLogic
during the study. Optional NT-proBNP tests were conducted when clinically needed (e.g.,
patients hospitalized with HF symptoms). HeartLogic index of the day before each of
the NT-proBNP test dates was extracted. Based on HeartLogic alert state (i.e., IN
alert vs OUT of alert), NT-proBNP concentrations were divided into two groups and
compared using a one-way ANOVA.
Results
Of a total of 855 valid NT-proBNP tests in 741 patients with valid associated HeartLogic
index, 180 NT-proBNP concentrations were measured in 150 patients while the HeartLogic
alert state was IN alert, and 675 were measured in 616 patients while HeartLogic was
OUT of alert. Figure 1 shows when HeartLogic was IN alert, the NT-proBNP concentrations
(6957.9±10398.0 pg/ml) were significantly higher than those when HeartLogic was OUT
of alert (1675.5±4403.1 pg/ml) (p<0.001), and the median NT-proBNP concentration was
also higher (2224 pg/ml versus 561 pg/ml).
Conclusion
HF patients’ NT-proBNP concentrations were significantly elevated when HeartLogic
was IN alert status, consistent with the HeartLogic algorithm capturing clinical worsening
of HF status.
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Copyright
© 2020 Published by Elsevier Inc.
