Pulmonary Embolism Causing Inaccurate Readings of Cardiomems

Abstract

The CardioMEMSÔ HF System is a wireless pulmonary artery (PA) pressure monitoring system implanted in the left lower lobe (LLL) PA branch; FDA approved in the management of heart failure (HF) patients with New York Heart Association (NYHA) class III symptoms and at least one hospitalization within the last year. This hemodynamic data is useful to reduce HF hospitalizations and mortality (1,2). We present the first reported case of a device-unrelated acute LLL pulmonary embolism (PE) leading to discordant CardioMEMS readings in a breast cancer patient with HF. CASE PRESENTATION:Patient is a 56 year-old female with past medical history of triple negative right breast cancer in 1998 treated with lumpectomy, anthracyclines, and radiation therapy that was complicated by recurrence in 2018 which was treated with bilateral mastectomy followed by adjuvant dose dense chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel that resulted in anthracycline-induced cardiomyopathy with reduced left ventricular ejection fraction (LVEF) of 30%. LVEF eventually recovered to 60% after the initiation of optimal medical therapy for HF. Unfortunately, she remained with persistent NYHA class III symptoms requiring frequent hospitalizations. Thus, a CardioMEMS device was inserted to optimize HF management and reduce recurrent hospitalization by remote monitoring of PA pressure. Eight months later, she developed an acute PE within the LLL PA branch (originating from her left leg). She was eventually treated with anticoagulation therapy with resolution of her dyspnea and was eventually discharged home. On her post-hospitalization appointment, she reported worsening HF symptoms despite being euvolemic on exam. CardioMEMS (2 months after PE) showed persistently elevated PA pressures. Due to concerns for PE into the LLL affecting the CardioMEMS readings, a right heart catheterization was performed which showed marked discrepancy between PA pressure and CardioMEMS readings.