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J Am Coll Cardiol, 2003; 41:565-571, doi:10.1016/S0735-1097(02)02896-6
© 2003 by the American College of Cardiology Foundation
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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*{dagger},*, Anthony Magalski, MD, FACC{ddagger}, Frieder Braunschweig, MD§, Michael Böhm, MD||, Dwight Reynolds, MD, FACC*, David Steinhaus, MD, FACC{ddagger}, 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
{dagger} Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
{ddagger} 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.

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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