Hemodynamic changes before acute heart failure episodes in patients with advanced systolic left ventricular...

Area of Science:

• Cardiology
• Cardiovascular Physiology
• Medical Devices

Background:

• Advanced systolic left ventricular (LV) dysfunction often leads to chronic heart failure (HF).
• Continuous hemodynamic monitoring can potentially predict HF decompensation before symptom onset.
• Right ventricular (RV) pressures are critical indicators of cardiac function in HF.

Purpose of the Study:

• To identify specific changes in right ventricular pressures that precede acute heart failure (HF) decompensation.
• To evaluate the utility of implantable hemodynamic monitoring in patients with advanced LV systolic dysfunction.

Main Methods:

• Implanted a device to monitor right ventricular systolic pressure (RVSP), right ventricular diastolic pressure (RVDP), and estimate pulmonary artery diastolic pressure (ePAD).
• Monitored 10 patients with advanced LV systolic dysfunction (NYHA classes IIIb-IV, LVEF 21%) and frequent hospitalizations.
• Analyzed hemodynamic data for 18 hospitalizations due to acute HF over a 15-month follow-up.

Main Results:

• An increase in RVDP was the most frequent hemodynamic change preceding acute HF hospitalizations.
• RVDP increased before 10 HF hospitalizations (pulmonary congestion or low-cardiac output).
• RVSP and ePAD also showed increases before some hospitalizations, but less consistently than RVDP.

Conclusions:

• Elevated RVDP is a key indicator for impending acute HF in patients with severe LV systolic dysfunction.
• Implantable hemodynamic monitoring effectively detects pre-symptomatic hemodynamic shifts in HF patients.
• RVDP monitoring may aid in proactive management of advanced systolic LV dysfunction.