CLINICAL STUDY: HEART FAILURE
Ongoing right ventricular hemodynamics in heart failure
clinical value of measurements derived from an implantable monitoring system
Philip B. Adamson, MD, FACC* ,*,
Anthony Magalski, MD, FACC ,
Frieder Braunschweig, MD ,
Michael Böhm, MD||,
Dwight Reynolds, MD, FACC*,
David Steinhaus, MD, FACC,
Allyson Luby, RN*,
Cecilia Linde, MD,
Lars Ryden, MD,
Bodo Cremers, MD||,
Teri Takle, MSc¶ and
Tom Bennett, PhD¶
* Department of Internal Medicine, Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Mid-America Heart Institute, Kansas City, Kansas, USA
Cardiology Department, Karolinska Hospital, Stockholm, Sweden
|| University Clinic, Homburg/Saar, Germany
¶ Medtronic Heart Failure Management, Minneapolis, Minnesota, USA
Manuscript received June 18, 2002;
revised manuscript received September 23, 2002,
accepted October 10, 2002.
* Reprint requests and correspondence: Dr. Philip B. Adamson, University of Oklahoma Health Sciences Center, Medicine/Cardiology, P.O. Box 26901, WP3120, Oklahoma City, Oklahoma 73190, USA.
philip-adamson{at}ouhsc.edu
OBJECTIVES: This study examined the characteristics of continuously measured right ventricular (RV) hemodynamic information derived from an implantable hemodynamic monitor (IHM) in heart failure patients.
BACKGROUND: Hemodynamic monitoring might improve the day-to-day management of patients with chronic heart failure (CHF). Little is known about the characteristics of long-term hemodynamic information in patients with CHF or how such information relates to meaningful clinical events.
METHODS: Thirty-two patients with CHF received a permanent RV IHM system similar to a single-lead pacemaker. Right ventricular systolic and diastolic pressures, heart rate, and pressure derivatives were continuously measured for nine months without using the data for clinical decision-making or management of patients. Data were then made available to clinical providers, and the patients were followed up for 17 months. Pressure characteristics during optimal volume, clinically determined volume-overload exacerbations, and volume depletion events were examined. The effect of IHM on hospitalizations was examined using the patients’ historical controls.
RESULTS: Long-term RV pressure measurements had either marked variability or minimal time-related changes. During 36 volume-overload events, RV systolic pressures increased by 25 ± 4% (p < 0.05) and heart rate increased by 11 ± 2% (p < 0.05). Pressure increases occurred in 9 of 12 events 4 ± 2 days before the exacerbations requiring hospitalization. Hospitalizations before using IHM data for clinical management averaged 1.08 per patient year and decreased to 0.47 per patient-year (57% reduction, p < 0.01) after hemodynamic data were used.
CONCLUSIONS: Long-term ambulatory pressure measurements from an IHM may be helpful in guiding day-to-day clinical management, with a potentially favorable impact on CHF hospitalizations.
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Abbreviations and Acronyms
| | CHF | | chronic heart failure | | ePADP | | estimated pulmonary artery diastolic pressure | | HF | | heart failure | | HR | | heart rate | | ICD | | implantable cardiac defibrillator | | IHM | | implantable hemodynamic monitor | | RV | | right ventricle or ventricular | | RVDP | | right ventricular diastolic pressure | | RVSP | | right ventricular systolic pressure |
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