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Background: Hemodynamic-guided management with a pulmonary artery pressure sensor (CardioMEMS) is effective in reducing heart failure hospitalization in patients with chronic heart failure. This study aims to determine the feasibility and clinical utility of the CardioMEMS heart failure system to manage patients supported with left ventricular assist devices (LVADs)., Methods: In this multicenter prospective study, we followed patients with HeartMate II (n=52) or HeartMate 3 (n=49) LVADs and with CardioMEMS PA Sensors and measured pulmonary artery pressure, 6-minute walk distance, quality of life (EQ-5D-5 L scores), and heart failure hospitalization rates through 6 months. Patients were stratified as responders (R) and nonresponders to reductions in pulmonary artery diastolic pressure (PAD)., Results: There were significant reductions in PAD from baseline to 6 months in R (21.5-16.5 mm Hg; P <0.001), compared with an increase in NR (18.0-20.3; P =0.002), and there was a significant increase in 6-minute walk distance among R (266 versus 322 meters; P =0.025) compared with no change in nonresponder. Patients who maintained PAD <20 compared with PAD ≥20 mm Hg for more than half the time throughout the study (averaging 15.6 versus 23.3 mm Hg) had a statistically significant lower rate of heart failure hospitalization (12.0% versus 38.9%; P =0.005)., Conclusions: Patients with LVAD managed with CardioMEMS with a significant reduction in PAD at 6 months showed improvements in 6-minute walk distance. Maintaining PAD <20 mm Hg was associated with fewer heart failure hospitalizations. Hemodynamic-guided management of patients with LVAD with CardioMEMS is feasible and may result in functional and clinical benefits. Prospective evaluation of ambulatory hemodynamic management in patients with LVAD is warranted., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT03247829., Competing Interests: Disclosures Dr Thohan is a consultant for Abbott, Impulse Dynamics, and Battelle and participated in Speaker’s Bureau for Pfizer and Boehringer Ingelheim. Dr Abraham is a consultant for Abbott and Abiomed. A. Burdorf participated in Speaker’s Bureau for Abbott. Dr Pagani works for Scientific Advisory Board for FineHeart Inc. Dr Vidula received research grant funding from Abbott and is supported by National Institutes of Health (NIH) grant 1R01HL155201-01. Dr Heywood received Speaker’s Honoraria and research support from Abbott. Dr Cogswell received Speaker’s Honoraria for Abbott. He is third party employed at Medtronic (spouse). N. Dirckx and Dr Farrar are Abbott Employees. Dr Drakos is a consultant for Abbott. He received research support from Novartis, Merck, NIH, American Heart Association, Department of Veterans Affairs, and Nora Eccles Treadwell Foundation. The other authors report no conflicts.

Background: Left ventricular diastolic dysfunction has been well described; diastolic abnormalities of the LA are less frequently recognized and poorly understood., Objective: The purpose of this study was to investigate the clinical, hemodynamic and echocardiographic features of left atrial (LA) diastolic dysfunction., Methods: Patients with atrial fibrillation (AF), severe LA enlargement, and pulmonary venous hypertension (PVH, Group 1) were compared to patients with pulmonary arterial hypertension (PAH), normal LA size and sinus rhythm (Group 2). All underwent right heart catheterization and transthoracic echo to evaluate hemodynamics and LA function. Mitral regurgitation was evaluated by transesophageal echocardiography. LA diastolic function was measured by comparing filling fraction, pulmonary venous flow and compliance., Results: Right atrial, pulmonary artery systolic and mean pressures were similar. Mean wedge pressure were increased in Group 1, 20.8±2.6 versus 9.7±2.8 mm of Hg (p<0.0001). The most striking hemodynamic difference was large V wave in Group 1 without significant mitral regurgitation. LA filling fraction was abnormal in Group 1, 11.4%±8.5 compared to Group 2, 111.5%±44 (p<0.0001). LA compliance was 0.39±0.27 ml/m2/mmHg in Group 1 versus 6.8±4.54 ml/m2/mmHg in Group 2 (p=0.001). There was a strong negative correlation between the V wave and LA filling fraction (r= 0.756, p<0.001). The ratio of the height of the transmitral E wave divided by the S/D ratio (the LA diastolic dysfunction index) correlated very strongly with the V wave (r=0.907, p<0.001)., Conclusion: LA diastolic dysfunction is present in some patients with long standing AF and PVH. LA diastolic dysfunction, in addition to left ventricular diastolic dysfunction, may contribute to the syndrome of heart failure with preserved left ventricular systolic function.