Relationship Between Ambulatory Pulmonary Artery Pressures and Heart Failure Hospitalizations in Patients With...

Pulmonary artery pressure (PAP) monitors provide ambulatory hemodynamic assessment of patients with chronic heart failure (HF).

The current analysis was designed to determine whether baseline systolic, diastolic, and mean PAPs and changes in PAPs from baseline to 6 months each were independent predictors of a heart failure hospitalization (HFH) within 2 years.

Retrospective analysis of CardioMEMS data from 4 studies including CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes) (n = 550), GUIDE-HF (Hemodynamic-GUIDEed Management of Heart Failure) (n = 2,358), US PAS (CardioMEMS HF System Post Approval Study) (n = 1,200), and MEMS-HF (CardioMEMS Monitoring Study for Heart Failure) (n = 234) included all enrolled patients regardless of treatment assignment (N = 4,342), reduced ejection fraction (<50%) (n = 2,562), and preserved ejection fraction (≥50%) (n = 1,454). Relationships between baseline pressure (averaged over 14 days after implantation) and change in pressure from baseline to 6 months (averaged over 14 days just before the 6-month time point) and HFH risk were evaluated over a 2-year follow-up.

Baseline diastolic PAP was an independent predictor of HFH (HR: 1.043 [95% CI: 1.035-1.050]; P < 0.0001). Change in diastolic PAP (baseline to 6 months, assessed as a continuous variable) was an independent predictor of HFH (landmark analysis; HR: 1.047 [95% CI: 1.035-1.0506]; P < 0.0001). A decrease or increase of >2 mm Hg in diastolic PAP (baseline to 6 months, assessed as categorical variable) compared with no change predicted a 16.1% decrease and 50.1% increase in HFH (P < 0.0001). Results were comparable for systolic and mean PAPs and for patients with HF with reduced ejection fraction and HF with preserved ejection fraction.

Baseline PAP and change in PAP from baseline to 6 months (systolic, diastolic, and mean) were independent predictors of HFH within 2 years. Current and previous data from 4 studies using CardioMEMS indicate that PAP is an independent predictor of both mortality and HFH.