A Steep Increase in the HeartLogic Index Predicts COVID-19 Disease in an Advanced Heart Failure Patient

Abstract

<jats:p>We present a patient with severe nonischemic cardiomyopathy in whom the HeartLogic algorithm was activated on her Boston Scientific cardioverter defibrillator. She had an out-of-alert state for several months and had clinically “stable” heart failure with no hospitalizations in the last 6 months. A sudden and fast increase of the HeartLogic index preceded her presentation in the emergency ward by several days. The detailed readout of HeartLogic however had some atypical features for heart failure decompensation. The patient presented at the emergency department with an increased dyspnea and a dry cough. Clinical exam showed desaturation and was suggestive for an acute respiratory infection. Subsequent imaging with CT thorax and nasopharyngeal real-time polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 viral pneumonia (COVID-19). This case illustrates that a timely and detailed analysis of HeartLogic alerts could help in the early differentiation of disease in patients with severe heart failure.</jats:p>

Case Reports of Implantable Cardiac Device Physiologic Sensor Changes in Subjects with Coronavirus Disease-2019 Infection

“… 8 , 9 The precise reason as to why the thoracic impedance increases with SARS-CoV-2 infection is not well-understood. However, this finding is consistent with findings from Heggermont et al, 10 who described a similar phenomenon of increasing thoracic impedance in a hospitalized patient with SARS-CoV-2 infection. Furthermore, in all of our cases, S1 heart sound increased with infection, in contrast with the decrease expected in decompensated heart failure.…”

Multiparameter diagnostic sensor measurements in heart failure patients presenting with SARS‐CoV‐2 infection

“… 18 Numerous individual case studies with HeartLogic capable devices and SARS‐CoV‐2 infections have also suggested that individual sensors may help identify patients who are COVID‐19 positive, even before patients themselves report symptoms. 19 , 20 , 21 , 22 The sensor changes reported in these individual cases are consistent with the quantitative trends that we report here, including increasing respiratory rate and impedance.…”

A reproducible sensor pattern to suspect COVID19 pulmonary infection with LATITUDE. Case report and literature review

“…From our review of the literature, we found two case reports 8 , 9 and 2 case series 10 , 11 reporting the HL physiologic sensor changes, for a total of eight patients with SARS‐CoV‐2 infection. As represented in Table 1 , the patients were all infected by SARS‐CoV‐2 and even though only 3/8 patients had a more severe clinical manifestation with pneumonia, in 8/8 patients (100%) an increase in the ITI in association with an increase in the RR and a decrease in the activity level was present.…”

“…This pattern seems to be related to SARS‐CoV‐2 infection, as it differs from what happens during impending HF, where a rapid shallow breathing pattern associated with a decrease of the activity level is common, 4 in association with a decrease in ITI, because of fluid overload due to HF. 12 Lung hyperinflation with air trapping 9 can be the reason of the increased ITI in SARS‐CoV‐2 infection. Heart sounds are also clinical relevant parameters that can vary during HF: S1 is associated with ventricular contraction status 4 and is supposed to decrease during heart acute decompensation; on the other hand S3 reflects the early diastolic filling, and is a pathophysiological landmark of acute HF.…”