Monitoring Pulmonary Arterial Hypertension Using an Implantable Hemodynamic Sensor

Benza, Raymond L.; Doyle, Mark; Lasorda, David; Parikh, Kishan S.; Correa-Jaque, Priscilla; Badie, Nima; Ginn, Greg; Airhart, Sophia; Franco, Verónica; Kanwar, Manreet; Murali, Srinivas; Raina, Amresh; Agarwal, Rahul; Rajagopal, Sudarshan; White, Jason; Biederman, Robert W

doi:10.1016/j.chest.2019.06.010

Cited by 40 publications

(36 citation statements)

References 24 publications

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“…Routine right heart catheterization (RHC) was not part of our protocol post transition in patients with CardioMEMS TM because We have demonstrated previously that monitoring PAH therapy using CardioMEMS TM is safe and feasible. 9 In addition, Case three and four were part of NHLBI funded pilot study in which we did have access to a proprietary CardioMEMS TM -derived stroke volume and cardiac output algorithm, which allowed calculation of total pulmonary resistance (TPR), a close surrogate of pulmonary vascular resistance (PVR), in patients with normal wedge pressure. Thus, we were able to monitor CO and TPR in close to real time during the transition.…”

Section: Discussionmentioning

confidence: 99%

Transition from parenteral prostacyclins to selexipag: safety and feasibility in selected patients

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Transition from parenteral prostacyclins to selexipag: safety and feasibility in selected patients

et al. 2021

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“…Accuracy of risk prediction may benefit from a high number of included risk factors, as the highly comprehensive REVEAL 2.0 score was reported to be of superior predictive power as compared to the FPHR and COMPERA models [ 10 ]. Still, in the herein presented PAH/CTEPH cohort according to c-index calculation, the REVEAL 2.0 tool did not significantly outperform ERS/ESC based risk assessment tools but achieved a similar C-index compared to its establishment within the REVEAL cohort [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Risk assessment in precapillary pulmonary hypertension: a comparative analysis

et al. 2021

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Background Risk stratification is essential to assess mortality risk and guide treatment in patients with precapillary pulmonary hypertension (PH). We herein compared the accuracy of different currently used PH risk stratification tools and evaluated the significance of particular risk parameters. Methods We conducted a retrospective longitudinal observational cohort study evaluating seven different risk assessment approaches according to the current PH guidelines. A comprehensive assessment including multi-parametric risk stratification was performed at baseline and 4 yearly follow-up time-points. Multi-step Cox hazard analysis was used to analyse and refine risk prediction. Results Various available risk models effectively predicted mortality in patients with precapillary pulmonary hypertension. Right-heart catheter parameters were not essential for risk prediction. Contrary, non-invasive follow-up re-evaluations significantly improved the accuracy of risk estimations. A lack of accuracy of various risk models was found in the intermediate- and high-risk classes. For these patients, an additional evaluation step including assessment of age and right atrium area improved risk prediction significantly. Discussion Currently used abbreviated versions of the ESC/ERS risk assessment tool, as well as the REVEAL 2.0 and REVEAL Lite 2 based risk stratification, lack accuracy to predict mortality in intermediate- and high-risk precapillary pulmonary hypertension patients. An expanded non-invasive evaluation improves mortality risk prediction in these individuals.

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“…The key concept supporting the utility of this device is that measurable and actionable filling pressure elevations may long precede clinical decompensation 25 (Figure 1). Among 26 patients with PAH and NYHA Class III or IV HF, the Cardi-oMEMS HF System was safely used to monitor PAH therapy, with no apparent device-related serious adverse events 26 . Using trends of CardioMEMS HF device-generated data, the study showed significant reduction in pulmonary artery pressure and improved cardiac output as early as one-month postimplant ( Figure 2).…”

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Risk assessment in patients with pulmonary arterial hypertension in the era of COVID 19 pandemic and the telehealth revolution: State of the art review

Milks

Sahay

Benza

et al. 2021

The Journal of Heart and Lung Transplantation

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Patients affected by pulmonary arterial hypertension (PAH) benefit from intensive, continuous clinical monitoring to guide escalation of treatments that carry the potential to improve survival and quality of life. During the COVID-19 pandemic, the need for physical distancing has fueled the expeditious expansion of various telehealth modalities, which may apply in a unique manner to individuals with PAH. Performance of objective risk assessments in patients with PAH remotely via telemedical visits and other telehealth mechanisms is unprecedented and not yet rigorously validated. The uniquely high risk for rapid deterioration in PAH patients demands a high degree of sensitivity to detect changes in functional assessments. In this review, several telehealth modalities for potential utilization in risk assessment and treatment titration in patients with PAH are explored, yet additional study is needed for their validation with the pre-pandemic care paradigm.

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Monitoring Pulmonary Arterial Hypertension Using an Implantable Hemodynamic Sensor

Cited by 40 publications

References 24 publications

Transition from parenteral prostacyclins to selexipag: safety and feasibility in selected patients

Transition from parenteral prostacyclins to selexipag: safety and feasibility in selected patients

Risk assessment in precapillary pulmonary hypertension: a comparative analysis

Risk assessment in patients with pulmonary arterial hypertension in the era of COVID 19 pandemic and the telehealth revolution: State of the art review

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