Continuous ambulatory right heart pressure measurements with an implantable hemodynamic monitor: A multicenter, 12-month follow-up study of patients with chronic heart failure

Home Monitoring Heart Failure Care Does Not Improve Patient Outcomes

“…Passive fixation of the sensing lead within the right ventricular outflow tract permitted continuous measurement of hemodynamic parameters, including right ventricular systolic and diastolic pressures, maximal rate of change in right ventricular pressure, and estimated pulmonary artery diastolic pressure. 44 In the Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure (COMPASS-HF) study, 274 patients with heart failure and NYHA class III to IV symptoms, independent of ejection fraction, underwent implantation of the Chronicle device. Subjects were then randomized to management with or without the hemodynamic information from the monitor.…”

T.M.I. (Too Much Information)?

“…One possibility is that our assumptions regarding the pathophysiology or mechanism driving an episode of decompensated HF leading to hospitalization are incorrect, or in part incorrect. The use of devices that can provide ongoing readouts of pulmonary artery 4 or left atrial pressures, 5 or those that examine intrathoracic impedance, 6 have suggested that an episode of decompensated HF leading to hospitalization is often preceded by a prolonged subclinical period of a slow increase of pulmonary pressures (suggesting increasing left atrial pressures) or reduction in impedance (suggesting slow accumulation of fluid). These studies led to the enticing possibility that targeting therapy during that subclinical period could reduce the likelihood of clinical decompensation.…”

Continuous and less invasive central hemodynamic monitoring by blood pressure waveform analysis

“…A few teams have applied techniques designed for ABP waveforms to the pulmonary artery pressure (PAP) waveform to try to improve CO estimation reliability (but at the cost of increased invasiveness) (22,32,111,126,127). Bennett and coworkers (50) have more recently tailored one of these techniques to the RVP waveform to track CO with their implantable RVP monitor for heart failure patients (63,80). However, these PAP and RVP waveform analysis techniques may not yield greater accuracy (22,111), as the waveforms are similarly confounded by wave reflections in addition to inertial effects in the low-resistance pulmonary circulation [see, e.g., complex PAP diastolic decays in Fig.…”