Rationale and Design of the Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy Study (LAPTOP-HF)

Maurer, Mathew S.; Adamson, Philip B.; Costanzo, María Rosa; Eigler, Neal; Gilbert, Joanne; Gold, Michael R.; Klapholz, Marc; Saxon, Leslie A.; Singh, Jagmeet P.; Troughton, Richard W.; Abraham, William T.

doi:10.1016/j.cardfail.2015.04.012

Cited by 71 publications

(43 citation statements)

References 23 publications

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“…1,[22][23][24] In these studies, the most common (but not only) medication alteration used was an adjustment in diuretic dose to reduce volume. 11,25 This may appear contradictory when compared with both diuretic and ultrafiltration trial results in which an increased diuretic-induced or ultrafiltration-induced volume loss was not accompanied by an improvement in morbidity and mortality.…”

Section: Pathophysiologic Implications and Results Of Diuretic Trialsmentioning

confidence: 99%

“…[34][35][36][37] It seems likely that small, incremental, progressive volume adjustments could avoid RAAS/SNS activation and lead to lower filling pressures. It is just this strategy that the leadership committees advocated and investigators achieved in the CHAMPION, REDUCE-HF, and HOMEOSTASIS (Hemodynamically Guided Home Self-Therapy in Severe Heart Failure Patients) studies (1,12,(22)(23)(24). In these studies, small daily changes in diuretics were combined with significant titration of nitrates, RAAS, and SNS antagonists.…”

Section: Pathophysiologic Implications and Results Of Diuretic Trialsmentioning

confidence: 99%

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Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor

Zile

Bennett

Hajj

et al. 2017

Circ: Heart Failure

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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.

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Section: Pathophysiologic Implications and Results Of Diuretic Trialsmentioning

confidence: 99%

Section: Pathophysiologic Implications and Results Of Diuretic Trialsmentioning

confidence: 99%

Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor

Zile

Bennett

Hajj

et al. 2017

Circ: Heart Failure

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“…Compared with historical controls, there were significant reductions in HF-related events and filling pressures. The subsequent randomised Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy (LAPTOP-HF)14 trial was stopped prematurely by the data and safety monitoring board due to implant-related trans-septal complications requiring pericardiocentesis or surgical repair.…”

Section: Remote Haemodynamic Monitoringmentioning

confidence: 99%

Chronic heart failure management and remote haemodynamic monitoring

Wolfson

Fong

Grazette

et al. 2018

Heart

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Heart failure (HF) has a large societal and economic burden and is expected to increase in magnitude and complexity over the ensuing years. A number of telemonitoring strategies exploring remote monitoring and management of clinical signs and symptoms of congestion in HF have had equivocal results. Early studies of remote haemodynamic monitoring showed promise, but issues with device integrity and implantation-associated adverse events hindered progress. Nonetheless, these early studies established that haemodynamic congestion precedes clinical congestion by several weeks and that remote monitoring of intracardiac pressures may be a viable and practical management strategy. Recently, the safety and efficacy of remote pulmonary artery pressure-guided HF management was established in a prospective, single-blind trial where randomisation to active pressure-guided HF management reduced future HF hospitalisations. Subsequent commercial use studies reinforced the utility of this technology and post hoc analyses suggest that tight haemodynamic management of patients with HF may be an additional pillar of therapy alongside established guideline-directed medical and device therapy. Currently, there is active exploration into utilisation of this technology and management paradigm for the timing of implantation of durable left ventricular assist devices (LVAD) and even optimisation of LVAD therapy. Several ongoing clinical trials will help clarify the extent and utility of this strategy along the spectrum of patient with HF from individuals with chronic, stable HF to those with more advanced disease requiring heart replacement therapy.

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“…Left atrial pressure guided medical therapy was associated with an improved event-free survival (death or hospitalization for acute decompensated HF), reduced mean daily left atrial pressures, improved New York Heart Association (NYHA) functional class, improved left ventricular ejection fraction, increased doses of neuro-hormonal antagonists, and reduced diuretic doses[13]. Encouraging results from this smaller study formed the basis of the larger and currently ongoing LAPTOP-HF trial which will investigate the role of implantable left atrial pressure monitoring in conjunction with a new HF treatment paradigm across the spectrum of HF patients[14]. …”

Section: Remote Hemodynamic Monitoring In Hf Patientsmentioning

confidence: 99%

Ambulatory pulmonary artery pressure monitoring in advanced heart failure patients

Yandrapalli¹,

Raza²,

Tariq³

et al. 2017

WJC

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Heart failure (HF) is an emerging epidemic associate with significant morbidity, mortality, and health care expenditure. Although there were major advances in pharmacologic and device based therapies for the management of HF, mortality of this condition remains high. Accurate monitoring of HF patients for exacerbations is very important to reduce recurrent hospitalizations and its associated complications. With the failure of clinical signs, tele-monitoring, and laboratory bio-markers to function as early markers of HF exacerbations, more sophisticated techniques were sought to accurately predict the circulatory status in HF patients in order to execute timely pharmacological intervention to reduce frequent hospitalizations. CardioMEMSTM (St. Jude Medical, Inc., Saint Paul, Minnesota) is an implantable, wireless pulmonary arterial pressure (PAP) monitoring system which transmits the patient’s continuous PAPs to the treating health care provider in the ambulatory setting. PAP-guided medical therapy modification has been shown to significantly reduce HF-related hospitalization and overall mortality. In advanced stages of HF, wireless access to hemodynamic information correlated with earlier left ventricular assist device implantation and shorter time to heart transplantation.

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Rationale and Design of the Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy Study (LAPTOP-HF)

Cited by 71 publications

References 23 publications

Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor

Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor

Chronic heart failure management and remote haemodynamic monitoring

Ambulatory pulmonary artery pressure monitoring in advanced heart failure patients

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