Search

Background: Ambulatory hemodynamic monitoring (AHM) using an implantable pulmonary artery pressure sensor (CardioMEMS) is effective in improving outcomes for patients with heart failure. The operations of AHM programs are crucial to clinical efficacy of AHM yet have not been described., Methods and Results: An anonymous, voluntary, web-based survey was developed and emailed to clinicians at AHM centers in the United States. Survey questions were related to program volume, staffing, monitoring practices, and patient selection criteria. Fifty-four respondents (40%) completed the survey. Respondents were 44% (n = 24) advanced HF cardiologists and 30% (n = 16) advanced nurse practitioners. Most respondents practice at a center that implants left ventricular assist devices (70%) or performs heart transplantation (54%). Advanced practice providers provide day-to-day monitoring and management in most programs (78%), and use of protocol-driven care is limited (28%). Perceived patient nonadherence and inadequate insurance coverage are cited as the primary barriers to AHM., Conclusions: Despite broad US Food and Drug Administration approval for patients with symptoms and at increased risk for worsening heart failure, the adoption of pulmonary artery pressure monitoring is concentrated at advanced heart failure centers, and modest numbers of patients are implanted at most centers. Understanding and addressing the barriers to referral of eligible patients and to broader adoption in community heart failure programs is needed to maximize the clinical benefits of AHM., Competing Interests: Declaration of Competing Interest AB is a consultant for Abbott. TAB is on the speaker's bureau for Abbott, KB is on the speaker's bureau for Abbott, Pfizer, and Novartis and a consultant for Abbott. AS has received research funding from Abbott, Edwards Lifesciences, Vifor, Pfizer, Bayer, General Prognostics, Story Health, Acorai, Boston Scientific, and Impulse Dynamics; is on the steering committees of Abbott, Boston Scientific, Biotronik, Story Health, RIVUS, Bayer, and General Prognostics; and is a consultant for Abbott, Boston Scientific, Edwards Lifesciences, Impulse Dynamics, Acorai, Story Health, General Prognostics, and BayerMF; TH has received research support from Abbott and Impedimed; and is a member of the speaker's bureau for Actelion Pharmaceuticals, Medtronic, Abbott, Boehringer Ingelheim, Bayer, and Lily. JA is a member of the speaker's bureau for Abbott and Abiomed; a consultant for Abbott and Abiomed; and a member of the steering committee for Abbott and Abiomed. The remaining authors declare no conflicts., (Copyright © 2023 Elsevier Inc. All rights reserved.)

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.

The objective of this study was to assess ambulatory hemodynamics after transcatheter edge-to-edge repair (TEER) of the mitral valve. Pulmonary artery pressure (PAP) measurements from implanted sensors were collected through a remote monitoring database and linked to Medicare fee-for-service claims data. Among patients with linked data, those undergoing TEER were included if the ambulatory PAP monitor was implanted ≥3 months before TEER and ≥3 months of PAP data after TEER were available. The primary end point was diastolic PAP (dPAP) at 3 months after TEER compared with baseline. A total of 50 patients undergoing TEER between July 2014 and March 2020 were included, with an average age of 75 ± 8 years and 70% were men. dPAP was significantly lower at 3 months after TEER than baseline, -1.8 ± 4.8 mm Hg, p = 0.010. The cumulative reduction in dPAP (area under the curve) was significantly lower at 3 months after TEER, 113 ± 267 mm Hg-days, p = 0.004. A reduction in dPAP at 3 months after TEER was independently associated with a significantly lower risk of heart failure hospitalization (p = 0.023). TEER of the mitral valve is associated with a clinically relevant and sustained reduction in dPAP., (Copyright © 2022 Elsevier Inc. All rights reserved.)

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.

Until March 1992, when it was transferred to St John's Hospital, Livingston, the Regional Plastic Surgery Service for Adults in the Lothians was based at Bangour, West Lothian. Plastic surgery for children continues to be provided by the same staff but at the Sick Children's Hospital in Edinburgh. With increasing interest in improving efficiency of care and audits several ways in which assessments can be done have been suggested. Case numbers alone may give a totally misleading impression of the amount and type of operative work carried out. By combining numbers with intermediate equivalent estimation a useful audit can be obtained.