Validating Left Ventricular Filling Pressure Measurements in Patients with Congestive Heart Failure: CardioMEMS™ Pulmonary Arterial Diastolic Pressure versus Left Atrial Pressure Measurement by Transthoracic Echocardiography

Abstract

Background Routine ambulatory echocardiographic estimates of left ventricular (LV) filling pressures are not cost-effective and are occasionally fraught with anatomic, physiologic as well as logistical limitations. The use of implantable hemodynamic devices such as CardioMEMS Heart Failure (HF) System has been shown to reduce HF-related readmission rates by remote monitoring of LV filling pressures. Little is known about the correlation between CardioMEMS and echocardiography-derived estimates of central hemodynamics. Methods We performed a prospective, single-center study enrolling seventeen participants with New York Heart Association functional class II-III HF and preimplanted CardioMEMS sensor. Simultaneous CardioMEMS readings and a limited echocardiogram were performed at individual clinic visits. Estimated left atrial pressure (LAP) by echocardiogram was calculated by the Nagueh formula. Linear regression was used as a measure of agreement. Variability between methods was evaluated by Bland–Altman analysis. Results Mean age was 74 ± 9 years; 59% (10/17) were males. LV systolic dysfunction was present in 76% (13/17) of subjects. Mean PAdP was 18 ± 4 mmHg and 19 ± 5 mmHg for CardioMEMS and echocardiographic-derived estimates, respectively, with a significant correlation between both methods (r2=0.798, p ≤ 0.001). Conclusions Our study illustrates a direct linear correlation between PAdP measured by CardioMEMS and simultaneous measurement of LV filling pressures derived by echocardiography.

Ballistocardiography to identify high left atrial pressure in patients with heart failure

“…PCWP measured by floating catheter and LVEDP measured by left ventricular catheter are commonly used as the gold standard for evaluating LVFP in clinical practice (17). The elevated LAP usually occurs before any symptoms of the hemodynamic cascade, which ultimately aggravates HF (18). Therefore, early assessment of LAP in patients with cardiac insufficiency may contribute to early prediction of HF.…”

Material property alterations for phenotypes of heart failure with preserved ejection fraction: A numerical study of subject-specific porcine models

“…Frontiers in Bioengineering and Biotechnology frontiersin.org of less than 1 mmHg are also considered minor (Tolia et al, 2018), since the physiologic pressures were estimated from E/e' measurements according to Nagueh's formula (Nagueh et al, 1997).…”

Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

“…Two studies have validated the PAP measured by the CardioMEMS, with cardiac filling pressures measured by Swan-Ganz catheterisation or echocardiography directly after implantation and after 6 months of follow-up [ 29 , 30 ]. Swan-Ganz measurements showed a good correlation with mean PAP assessed by CardioMEMS ( r 2 = 0.90 at implantation and r 2 = 0.94 at follow-up, p < 0.01) [ 30 ].…”

“…Swan-Ganz measurements showed a good correlation with mean PAP assessed by CardioMEMS ( r 2 = 0.90 at implantation and r 2 = 0.94 at follow-up, p < 0.01) [ 30 ]. Furthermore, a good correlation ( r 2 = 0.80 at implantation and r 2 = 0.75, both p < 0.01 at follow-up) was found between PAP measurements by the CardioMEMS and estimated pressure measurements by echocardiography [ 29 ].…”