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

Abstract

AimsRemote 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 resultsThis 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].ConclusionsDecreased 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.

Chronic heart failure management and remote haemodynamic monitoring

“…27 The AUC was significantly lower in the general use cohort compared with the CHAMPION treatment group; neither sex nor baseline EF impacted this finding. Overall, patients with higher baseline pressures had larger, more negative AUC values; not surprising as the magnitude of pressure reduction has been shown to be positively correlated with baseline pressures 28. While pressure reduction is achievable outside of the original clinical trial, the AUC method is a relative metric and may not be the most appropriate surrogate endpoint to track.…”