Continuous ambulatory monitoring of absolute right ventricular pressure and mixed venous oxygen saturation in patients with heart failure using an implantable haemodynamic monitor: results of a 1 year multicentre feasibility study

Ohlsson, Å; Kubo, Spencer H.; Steinhaus, David; Connelly, Derek T.; Adler, Stephen C.; Bitkover, Catarina; Nordlander, Rolf; Rydén, Lars; Bennett, Tom

doi:10.1053/euhj.2000.2419

Cited by 84 publications

(58 citation statements)

References 13 publications

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“…For example, previous studies with an implantable monitor showed an increase of 16Ϯ6 mm Hg, or a 71% increase, from baseline in ePAD during a 6-minute walk in 21 patients, although the highest pressures occurred briefly during activity other than during formal exercise. 3,8 These components of daily life integrate into the filling pressures measured during the entire 24-hour period, for which optimal levels have not previously been described.…”

Section: Discussionmentioning

confidence: 99%

“…5,7,8 The monitor continuously measures and stores heart rate and physical activity level, right ventricular (RV) systolic pressure (RVSP), RV end-diastolic pressures (RVEDP), and an estimated pulmonary artery diastolic pressure (ePAD), previously validated as a reliable estimate of pulmonary capillary wedge pressure and left ventricular diastolic pressure 8 in the absence of significant intrinsic pulmonary disease (which was an exclusion criterion). The institutional review board of each participating center approved the study protocol, and all patients provided written, informed consent.…”

Section: Monitoringmentioning

confidence: 99%

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Chronic Ambulatory Intracardiac Pressures and Future Heart Failure Events

Stevenson

Zile

Bennett

et al. 2010

Circ: Heart Failure

129

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Background-Intracardiac pressures in heart failure (HF) have been measured in patients while supine in the hospital but change at home with posture and activity. The optimal level of chronic ambulatory pressure is unknown. This analysis compared chronic intracardiac pressures to later HF events and sought a threshold above which higher pressures conferred worse outcomes. Methods and Results-Median pressures were measured every 24 hours from continuous 8-minute segments for 6 months after implantation of hemodynamic monitors in 261 patients with New York Heart Association class III-IV HF in the Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure Study. Baseline and chronic daily medians of estimated pulmonary artery diastolic, right ventricular systolic, and right ventricular end-diastolic pressures were compared with HF event rate. The group median for chronic 24-hour estimated pulmonary artery diastolic pressure was 28 mm Hg (excluding 7 days before and after events). Despite weight-guided management, events occurred in 100 of 261 (38%) patients. Event risk increased progressively with higher chronic 24-hour estimated pulmonary artery diastolic pressure, from 20% at 18 mm Hg to 34% at 25 mm Hg and 56% at 30 mm Hg, with similar relations for right ventricular pressures. Among patients with baseline day median estimated pulmonary artery diastolic pressures of Ն25 mm Hg, event risk was 1.10/6 mo when they remained chronically Ն25 mm Hg, but risk fell to 0.47 when 24-hour pressures declined to Ͻ25 mm Hg for more than half of the days. Conclusions-Despite current management, many patients with advanced HF live on a plateau of high filling pressures from which later events occur. This risk is progressively higher with higher chronic ambulatory pressures. It is not known whether more targeted intervention could maintain lower chronic ambulatory pressures and better outcomes. (Circ Heart Fail. 2010;3:580-587.)

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Section: Discussionmentioning

confidence: 99%

Section: Monitoringmentioning

confidence: 99%

Chronic Ambulatory Intracardiac Pressures and Future Heart Failure Events

Stevenson

Zile

Bennett

et al. 2010

Circ: Heart Failure

129

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“…The system components, implantation procedure, monitoring process, storage and retrieval methods, and pressure analysis methods have previously been described. 11,[15][16][17][18][19][20][21][22] The ePAD is defined as the RV pressure at the time of pulmonary valve opening, which occurs at the time of maximum dP/dt. 18,21 A strong correlation has been shown to exist between the ePAD and actual pulmonary artery diastolic pressures measured under a variety of physiological conditions.…”

Section: Device Description and Measurementsmentioning

confidence: 99%

Transition From Chronic Compensated to Acute Decompensated Heart Failure

Zile

Bennett²,

Sutton³

et al. 2008

Circulation

488

176

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Background-Approximately half of all patients with chronic heart failure (HF) have a decreased ejection fraction (EF) (systolic HF [SHF]); the other half have HF with a normal EF (diastolic HF [DHF]). However, the underlying pathophysiological differences between DHF and SHF patients are incompletely defined. The purpose of this study was to use echocardiographic and implantable hemodynamic monitor data to examine the pathophysiology of chronic compensated and acute decompensated HF in SHF versus DHF patients. Methods and Results-Patients were divided into 2 subgroups: 204 had EF Ͻ50% (SHF) and 70 had EF Ն50% (DHF).DHF patients had EF of 58Ϯ8%, end-diastolic dimension of 50Ϯ10 mm, estimated resting pulmonary artery diastolic pressure (ePAD) of 16Ϯ9 mm Hg, and diastolic distensibility index (ratio of ePAD to end-diastolic volume) of 0.11Ϯ0.06 mm Hg/mL. In contrast, SHF patients had EF of 24Ϯ10%, end-diastolic dimension of 68Ϯ11 mm, ePAD of 18Ϯ7 mm Hg, and diastolic distensibility index of 0.06Ϯ0.04 mm Hg/mL (PϽ0.05 versus DHF for all variables except ePAD). In SHF and DHF patients who developed acute decompensated HF, these events were associated with a significant increase in ePAD, from 17Ϯ7 to 22Ϯ7 mm Hg (PϽ0.05) in DHF and from 21Ϯ9 to 24Ϯ8 mm Hg (PϽ0.05) in SHF. As a group, patients who did not have acute decompensated HF events had no significant changes in ePAD. Conclusions-Significant structural and functional differences were found between patients with SHF and those with DHF; however, elevated diastolic pressures play a pivotal role in the underlying pathophysiology of chronic compensated and acute

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“…63 Other biochemical sensors have been suggested, but none has yet been successfully implemented in CIEDs (Figure 4). …”

Section: Biochemical Sensorsmentioning

confidence: 99%