Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor

Abstract

Background-The purpose of this analysis was to examine whether implantable hemodynamic monitor-derived baseline estimated pulmonary artery diastolic pressure (ePAD) and change from baseline ePAD were independent predictors of all-cause mortality in patients with chronic heart failure. Methods and Results-Retrospective analysis used data from 3 studies (n=790 patients; 216 deaths). Baseline ePAD was related to mortality using a multivariable model including baseline and demographic data. Changes in ePAD defined as change from baseline to 6 months and from baseline to 14 days before death or exit from study were related to subsequent mortality, and analysis was adjusted for baseline ePAD. Area under the pressure versus time curve during 180 days before death or exit from study was related to mortality. Baseline ePAD, independent of other covariates, was a significant predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.09; P<0.0001). Change in ePAD was an independent predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.100; P=0.0008). Increased ePAD of 3, 4, or 5 mm Hg from baseline to 6 months was associated with increased mortality risk of 23.8%, 32.9%, or 42.8%. Change in ePAD from baseline to 14 days before death or exit from study was higher in patients who died (3.0±8 versus 1.7±10 mm Hg; P=0.003). Area under the pressure versus time curve in the final 180 days before death or exit from study was higher in patients who died versus those alive at end of study (185±668 versus 17±482 mm Hg.days; P=0.006). Conclusions-Implantable hemodynamic monitor-derived baseline ePAD and change from baseline ePAD were independent predictors of mortality in chronic heart failure patients. (Circ Heart Fail. 2017;10:e003594.

Transcatheter Interatrial Shunt Device for the Treatment of Heart Failure With Preserved Ejection Fraction (REDUCE LAP-HF I [Reduce Elevated Left Atrial Pressure in Patients With Heart Failure])

“…25 Borlaug and colleagues 26 showed that elevated PCWP during exercise can distinguish patients with HFpEF from those with noncardiac dyspnea, and the rise in PCWP during exercise is an important pathophysiologic determinant of HFpEF early in the course of the clinical syndrome. PCWP during exercise also correlates with 6-minute walk test distance and is an important determinant of mortality in patients with HFpEF.…”

Less loop diuretic use in patients on sacubitril/valsartan undergoing remote pulmonary artery pressure monitoring

“…Supervision protocols and treatment algorithms have been published previously. 6,7,[20][21][22] The majority of medication changes in MEMS-HF was due to dose increases of diuretics [1068 medication changes compared with 312 changes in angiotensin-converting enzyme (ACE) inhibitors, 209 changes in beta-blockers, and 170 changes in mineralocorticoid antagonists]. For diuretic dose equivalents in furosemide (loop diuretics) or metolazone (thiazides), see Table 1.…”

“…4 Pulmonary artery pressure (PAP) rises days and weeks before clinical signs and symptoms develop, 5 and early treatment with diuretics might be a tool to prevent hospitalizations. 6 It has been shown that titration of heart failure medications guided by haemodynamic parameters collected remotely (CardioMEMS HF System) is feasible, 7 reduces hospitalization, and improves quality of life. 8,9 Recently, outcomes from studies using the angiotensin receptor blocker/neprilysin inhibitor sacubitril/valsartan and studies with the sodium-glucose transporter 2 inhibitors (SGLT2i) dapagliflozin 10 and empagliflozin 11 have shown a reduction in cardiovascular death and hospitalization.…”

Telemedical Monitoring Based on Implantable Devices—the Evolution Beyond the CardioMEMS™ Technology

“…However, the majority of HF readmissions are due to fluid overload, and the process of decompensation may be prevented if clinical parameters are strictly controlled via telemedical monitoring [14,15]. The likelihood of adverse clinical outcomes increases when pulmonary artery pressure (PAP) rises, usually days to weeks before clinical manifestations of HF [16,17]. A wireless monitoring system (CardioMEMS™) detecting changes in PAP has been proposed for HF patients.…”