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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

View larger version (57K): [in a new window]   Figure 1 Actual right ventricular pressure waveforms derived from an implantable hemodynamic monitor (IHM) system, with an illustration of how the IHM determines the pressure values. dP/dt = contractility as measured by change in pressure over change in time; EGM = electrogram; ePAD = estimated pulmonary artery diastolic pressure; RVDP = right ventricular diastolic pressure; RVSP = right ventricular systolic pressure.

View larger version (105K): [in a new window]   Figure 2 Right ventricular pressure values from a patient with variable pressure (left panel) and a patient with nonvariable pressure (right panel) characteristics. (See text for details.) Nighttime minimum values are shown for heart rate (HR), RVSP, ePAD, and RVDP values. Abbreviations as in Figure 1.

View larger version (108K): [in a new window]   Figure 3 (A) Pressure changes occurred in 9 of 12 events 4 ± 2 days before hospitalization (major). (B) Pressure changes before minor exacerbations (n = 24) that did not require hospitalization. Percent changes in right ventricular systolic pressure (black circles), estimated pulmonary artery diastolic pressure (green diamonds), and heart rate (red triangles).