Abstract 700 Pulmonary artery pressure monitoring may be of limited efficacy in preventing right sided cardiac decompensation in chronic heart failure

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Pulmonary artery pressure monitoring may be of limited efficacy in preventing right sided cardiac decompensation in chronic heart failure – a single center experience
E. Herrmann¹, K. Tello², K. Mantzsch³, M. Tekeste³, S. Fichtlscherer³, C. W. Hamm¹, B. Aßmus¹
¹Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; ²Medizinische Klinik II - Pneumologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; ³Med. Klinik III - Kardiologie, Angiologie, Universitätsklinikum Frankfurt, Frankfurt am Main;
Aim: Patients with advanced heart failure (HF) suffer from frequent hospitalizations. Non-invasive pulmonary artery pressure (PAP) telemonitoring-guided HF care has been shown to reduce hospitalizations. However, it is unknown if there are differences between the PAP values in clinically left-sided, right-sided or globally decompensated patients and whether the pattern of PAP changes prior to hospitalization differs between the types of decompensations. Thus, we assessed hospitalizations and PAP data of 41 patients who received PAP-guided HF management at our Heart Failure Center. Methods: All HF hospitalization records were manually reviewed in order to clinically classify whether the patient was predominately left-sided (pulmonary congestion), right-sided (peripheral edema and / or ascites) or globally decompensated (pulmonary congestion and peripheral edema). Linear mixed effect regression models were used for statistical evaluations of PAP in selected hospitalizations with admissions at least 28 days after the last admission and 14 days after the last hospital discharge. Results: In our cohort (mean age 74 ± 2 years, left ventricular ejection fraction 27 ± 3%, cardiac index 2.0 ± 0.1), during an average follow-up of 24.4 months since PAP sensor implantation, 132 hospitalizations in 38 patients were further evaluated because they had a sufficient time delay with respect to the last hospital admission. Hospitalization for global cardiac decompensations (n = 13) had the highest PAP before hospitalization, followed by left-sided (n = 20) decompensation events, whereas right-sided decompensation events (n = 10) had comparable PAP values before hospitalization as the cohort without any decompensation. Diastolic PAP showed significant increases by 0.049 mmHg/day (p = 0.0007) in left-sided decompensation, and by 0.13 mmHg/day (p < 0.0001) in global cardiac decompensation, whereas no change in diastolic PAP occurred prior to right-sided decompensation. Interestingly, baseline right ventricular function and RV-PA coupling, as assessed non-invasively by TAPSE/PASP ratio at the time of sensor implantation, were already significantly impaired in patients with subsequent global cardiac decompensation but showed no impairment at baseline and just a slight impairment prior right-sided cardiac decompensation. Conclusion: PA-pressure telemonitoring-guided therapy can reliably detect early signs of left and global ventricular decompensation but may fail to detect predominately right-sided cardiac decompensation because of missing increase in pulmonary artery pressure. Additional clinical parameters like weight monitoring should therefore be recommended to maximize the benefit of telemedical care.
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