The CardioMEMS system in the clinical management of end-stage heart failure patients: three case reports

Abstract

BackgroundRecent clinical trials have shown that pulmonary artery pressure-guided therapy via the CardioMEMS™ system reduces the risk of recurrent hospitalizations in chronic heart failure (HF) patients. The CardioMEMS™ pressure sensor is percutaneously implanted in a branch of the pulmonary artery and allows telemetric pressure monitoring via a receiver. According to the most recent ESC guidelines, this technology has currently a class IIb indication in patients with class III New York Heart Association symptoms and a previous hospitalization for congestive heart failure within the last year, regardless of ejection fraction. Aim of this guided-therapy is multifold, including an early prediction of upcoming decompensation, optimization of patients’ therapy and thereby avoidance of hospital admissions. In addition, it can be used during acute decompensation events as a novel tool to direct intra-hospital therapeutic interventions such as inotropes infusion or left ventricular (LV) assist device monitoring, with the aim of achieving an optimal volume status.Case presentationWe present a case series of three end-stage HF patients with reduced ejection fraction (HFrEF) who received a CardioMEMS™ device as an aid in their clinical management. The CardioMEMS™ system enabled a closer non-invasive hemodynamic monitoring of these patients and guided the extent of therapeutic interventions. Patients were free from device- or system-related complications. In addition, no pressure-sensor failure was observed. Two patients received a 24-h infusion of the calcium sensitizer levosimendan. One patient showed a refractory acute decompensation and underwent LV assist device (LVAD) implantation as a bridge to cardiac transplantation. Switching a patient with recurrent hospitalizations to the Angiotensin Receptor Neprilysin Inhibitor (ARNI, Sacubitril-Valsartan) on top of the optimal heart failure-therapy improved its subjective condition and hemodynamics, avoiding further hospitalization.ConclusionsOur case series underlines the potential impact of CardioMEMS™ derived data in the daily clinical management of end-stage HF patients. The new concept to combine CardioMEMS™ in the setting of an outpatient levosimendan program as well as a bridge to LVAD-implantation/heart transplantation looks promising but needs further investigations.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0883-4) contains supplementary material, which is available to authorized users.

The emerging role of sacubitril/valsartan in pulmonary hypertension with heart failure

“…After implanting CardioMEMS™ in a 53-year-old patient with idiopathic dilated cardiomyopathy, the system detected a decrease in PAP, accompanied by an increase in LV ejection fraction and a decrease in NT-pro BNP. This case marks the first reported instance of ARNI improving PAP and cardiac function in a patient with HFrEF, as detected by telemetry data ( 122 , 123 ). In HFrEF patients with previously implanted CardioMEMS™ sensors, transitioning from ACEI/ARB to ARNI demonstrated a rapid decrease in PAP ( 69 ).…”

CardioMEMS: where we are and where can we go?

“…Feldman and colleagues recently investigated the applicability of CardioMEMS as a tool for optimization of LVAD implantation timing and there was a shorter time LVAD implantation and it enables better optimization of LVAD performance when compared to current methods (17). Similar findings were reiterated by Tschöpe et al in their case series whereby CardioMEMS led to better patient care when patients with end stage HF were transitioning to heart transplantation (18). In a 5-year cost effectiveness analysis of CardioMEMS, Schmier et al established that it would be cost effective and it would lead to better quality adjusted life-year (QALY) for patient when compared to standard therapy (19).…”

Short-term efficacy of angiotensin receptor-neprilysin inhibitor treatment in patients with ST-segment elevation myocardial infarction with reduced ejection fraction after primary percutaneous coronary intervention: a propensity score matching study

“…Furthermore, other effort has also been devoted to improve the prognosis of AMI patients such as the CardioMEMS™ system, left ventricular assist devices, etc. Expectedly, more AMI patients should survive with the help of these new monitoring and supporting devices [ 18 , 19 ].…”