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Remote invasive monitoring of pulmonary artery pressure in patients with heart failure: initial experience of a tertiary care center
Session:
Comunicações Orais (Sessão 10) - Insuficiência Cardíaca 1 - Parâmetros de Avaliação e Prognóstico
Speaker:
Vera Vaz Ferreira
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.5 Chronic Heart Failure – Prevention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Vera Ferreira; Tiago Pereira-Da-Silva; António Gonçalves; Rita Ilhão Moreira; João Alves; Sofia Barquinha; Carlos Franco; Miguel Trindade; Alexandra Castelo; Pedro Garcia Brás; Isabel Cardoso; Ana Timóteo; Duarte Cacela; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Background: </span></span></strong><span style="background-color:white"><span style="color:black">Decompensated heart failure (HF) is associated with poor short- and long-term prognosis. </span></span>Remote invasive monitoring of pulmonary artery pressure (PAP) enables an early detection of HF decompensations, before symptoms occur, and may improve clinical outcomes. We aimed to <span style="color:black">describe our initial experience with the use of the CardioMEMS™ remote monitoring system in patients with HF, including its</span> safety and effectiveness.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods and results:</span></strong> Ten patients with HF in New York Heart Association class III and at least one hospitalization due to decompensated HF in the last 12 months, who underwent invasive remote monitoring of PAP, were included in this prospective registry. The mean age was 65±13 years, nine were men and the mean LVEF was 30±8%. The median of HF admissions in the previous 12 months was 2 (IQR 1-3). All patients were receiving a β-blocker, an ACE inhibitor/ARB/ARNI and an aldosterone antagonist. Mean glomerular filtration rate was 52.3±12.5 mL/min per 1.73 m2, mean NT-proBNP was 4365±3628 pg/mL and mean baseline furosemide daily dosage was 64±35mg. The pulmonary artery (PA) sensor was placed in a left PA branch in all patients and no major procedural complications occurred. In a mean follow-up of 257±111 days, a total of 2314 pressure readings were transmitted, with a patient reading compliance of 97.8%. There was one (late) sensor failure due to device migration to a segmentary PA branch. During follow-up, PAP remained inside<span style="background-color:white"><span style="color:black"> the optimal range (which was individualized per patient) in 86.4% of readings. Of the 13.6% readings outside the optimal range, patients were asymptomatic in 87%. There was a need for </span></span>286 telephone contacts (about one per week) by the HF team with patients. <span style="background-color:white"><span style="color:black">E</span></span>ach patient had a median of 6 (IQR 3-7) medical adjustments due to increases in PAP to values above the targets, regardless of symptoms worsening. These required dietary and diuretic dose adjustments, leading to PAP reductions. One patient required an outpatient clinic visit for intravenous diuretic due to persisting PAP elevation. Only one hospitalization due to a non-cardiac cause was registered. No hospitalizations for HF or deaths occurred during follow-up. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong><span style="color:#131413">A haemodynamic-guided HF monitoring was safe and effective and may be a useful adjunctive tool to the standard-of-care management in selected HF patients, particularly in the context of COVID-19 pandemics, where a reduction in the number of health-care visits may be desirable. </span></span></span></p>
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