Baseline diastolic pressure gradient and pressure reduction in chronic heart failure patients implanted with the CardioMEMS™ HF sensor - PubMed (original) (raw)

Multicenter Study

Baseline diastolic pressure gradient and pressure reduction in chronic heart failure patients implanted with the CardioMEMS™ HF sensor

Aaron M Wolfson et al. ESC Heart Fail. 2018 Jun.

Abstract

Aims: Remote haemodynamic monitoring (RHM) decreases hospitalization rates in patients with chronic heart failure (HF). Many patients with chronic HF develop pulmonary hypertension (PH) secondary to left heart disease with some acquiring combined pre-capillary and post-capillary PH (Cpc-PH). The efficacy of RHM in achieving pulmonary pressure reductions in patients with Cpc-PH vs. isolated post-capillary PH (Ipc-PH) is unknown. The purpose of this study is to evaluate whether a higher baseline diastolic pressure gradient (DPGbaseline ) measured at the time of CardioMEMS™ HF sensor implantation is associated with lower reductions in pulmonary artery diastolic pressures (PADP).

Methods and results: This was a retrospective analysis of 32 patients meeting clinical indications for CardioMEMS™ implantation. DPGbaseline categorized patients as Cpc-PH (DPG ≥ 7 mmHg) or Ipc-PH (DPG < 7 mmHg). Minimum achievable PADP (PADPmin ) and ∆PADP (PADPbaseline - PADPmin ) were determined. Pearson's correlation analysis and comparison of mean pressure changes were assessed. Median age was 69 years, and median left ventricular ejection fraction (LVEF) was 25%. Eight patients (25%) had a LVEF ≥40%. Twenty-five patients (78%) met criteria for Ipc-PH and seven (22%) for Cpc-PH. Neither PADPmin (ρ = 0.27; P = 0.13) nor ΔPADP (ρ = 0.07; P = 0.72) was correlated with DPGbaseline . A trend towards higher ΔPADP was seen in Cpc-PH vs. Ipc-PH patients (15.2 vs. 9.88 mmHg; P = 0.12). There was a moderate positive correlation between baseline PADP and ΔPADP [ρ = 0.55 (0.26-0.76); P < 0.001].

Conclusions: Decreased PADP reduction was not seen in Cpc-PH vs. Ipc-PH patients. Higher PADPbaseline was associated with greater ΔPADP. Larger studies are needed to elaborate our findings.

Keywords: Combined pre-capillary and post-capillary pulmonary hypertension; Heart failure; Implantable haemodynamic monitoring; Isolated post-capillary pulmonary hypertension.

© 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

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Figures

Figure 1

Figure 1

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A) Minimum

pulmonary artery diastolic pressure (PADPmin) is plotted vs. baseline diastolic pressure gradient (DPG) for both isolated post‐capillary pulmonary hypertension (Ipc‐PH, closed circles) and combined pre‐capillary and post‐capillary pulmonary hypertension (Cpc‐PH, open circles) groups. (B) Change in pulmonary artery diastolic pressure (∆PADP) is plotted vs. baseline DPG for both Ipc‐PH (closed circles) and Cpc‐PH (open circles) groups. The correlation coefficient (with 95% confidence interval and P value) and mean PADPmin (A) and mean ∆PADP (B) for Ipc‐PH vs. Cpc‐PH (with P values comparing means) are shown superimposed on each figure. Each symbol represents one patient.

Figure 2

Figure 2

(A)

Minimum

pulmonary artery diastolic pressure (PADPmin) is plotted vs. baseline PADP and (B) ΔPADP vs. baseline PADP. Patients with isolated post‐capillary pulmonary hypertension (Ipc‐PH) are represented by closed circles and those with combined pre‐capillary and post‐capillary pulmonary hypertension (Cpc‐PH) by open circles. The respective correlation coefficient with 95% confidence interval and P value is superimposed on each panel. Each symbol represents one patient.

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