Background
The purpose of this study was to determine whether an implantable hemodynamic monitor
(IHM) could be used to judge the response of pulmonary arterial hypertension (PAH)
patients to changes in therapy.
Methods
A prospective, non-randomized, multi-center study evaluated physical examination,
functional class, echocardiography, brain natriuretic peptide (BNP) levels, exercise
capacity assessed by 6-minute walk and cardiopulmonary exercise tests, and quality
of life at baseline and at 12 weeks. IHM measurements were continuously available
to clinicians between clinic visits. Based on a priori, pre-specified analyses, the
relationships between hemodynamic values, PAH treatments and clinical parameters were
tracked in an observational fashion.
Results
Twenty-four PAH patients underwent IHM implantation prior to a change in PAH therapy.
IHM data identified 13 of the 15 patients who improved their 6-minute walk distance
by >30 m at 12 weeks (+48 ± 65 m, p < 0.05), whereas the others walked less (−78 ± 115 m, not statistically significant).
In addition, peak Vo2, BNP levels and Minnesota Living with Heart Failure Questionnaire scores only improved
in the former group. The change in mean pulmonary artery pressure correlated with
the change in 6-minute walk distance at 12 weeks (r = −0.71, p < 0.001). Device-related adverse events were comparable to those known to occur with
a pacemaker-like device.
Conclusions
Changes in ambulatory continuous hemodynamic measurements predicted changes in 6-minute
walk distance after the start or addition of PAH therapy. The IHM also identified
patients who had improved exercise tolerance, BNP levels and quality of life. The
IHM appeared to be well tolerated and allowed rapid hemodynamic feedback between clinic
visits.
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References
- Evaluation of pulmonary arterial hypertension.Curr Opin Cardiol. 2004; 19: 575-581
- Treatment of pulmonary arterial hypertension.N Engl J Med. 2004; 351: 1425-1436
- Medical therapy for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines.Chest. 2004; 126: 35S-62S
- Continuous subcutaneous infusion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension: a double-blind, randomized, placebo-controlled trial.Am J Respir Crit Care Med. 2002; 165: 800-804
- Bosentan therapy for pulmonary arterial hypertension.N Engl J Med. 2002; 346: 896-903
- Sildenafil citrate therapy for pulmonary arterial hypertension.N Engl J Med. 2005; 353: 2148-2157
- Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines.Chest. 2004; 126: 14S-34S
- Diagnosis and differential assessment of pulmonary arterial hypertension.J Am Coll Cardiol. 2004; 43: 40S-47S
- The current treatment of pulmonary arterial hypertension: time to redefine success.Chest. 2006; 130: 1198-1202
- Continuous ambulatory monitoring of absolute right ventricular pressure and mixed venous oxygen saturation in patients with heart failure using an implantable haemodynamic monitor: results of a 1 year multicentre feasibility study.Eur Heart J. 2001; 22: 942-954
- Continuous ambulatory right heart pressure measurements with an implantable hemodynamic monitor: 12-month follow-up in a multi-center trial of chronic heart failure patients.J Card Fail. 2002; 8: 63-70
- Hemodynamic observations in two pulmonary hypertensive patients changing treatment from inhaled iloprost to oral endothelin-antagonist bosentan.J Heart Lung Transplant. 2005; 24: 631-634
- Continuous haemodynamic monitoring in pulmonary hypertensive patients treated with inhaled iloprost.Chest. 2003; 124: 351-359
- Continuous hemodynamic monitoring during incremental exercise in patients with pulmonary hypertension treated with inhalative prostanoids.Int J Cardiol. 2005; 101: 415-420
- The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure.Can Med Assoc J. 1985; 132: 919-923
- Validity of the Minnesota Living with Heart Failure Questionnaire as a measure of therapeutic response to enalapril or placebo.Am J Cardiol. 1993; 71: 1106-1107
- Implant experience with an implantable hemodynamic monitor for the management of symptomatic heart failure.Pacing Clin Electrophysiol. 2005; 28 (747–5)
- Development of implantable devices for continuous ambulatory monitoring of central hemodynamic values in heart failure patients.Pacing Clin Electrophysiol. 2005; 28: 573-584
- Measurement of pulmonary artery diastolic pressure from a right ventricular pressure transducer in patients with heart failure.J Card Fail. 1996; 2: 41-46
- Measurement of pulmonary artery diastolic pressure from the right ventricle.J Am Coll Cardiol. 1995; 25: 1176-1182
- Trans-telephonic monitoring of continuous hemodynamic measurements in heart failure patients.J Telemed Telecare. 2005; 11: 240-244
- Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hypertension: a randomised placebo-controlled study.Lancet. 2001; 358: 1119-1123
- Prognosis of pulmonary arterial hypertension: ACCP evidence-based practice guidelines.Chest. 2004; 126: 78S-92S
- Assessment of pulmonary vascular resistance by Doppler echocardiography in patients with pulmonary arterial hypertension.J Heart Lung Transplant. 2007; 26: 927-934
- Efficacy of sildenafil as a rescue therapy for patients with severe pulmonary arterial hypertension and given long-term treatment with prostanoids: 2-year experience.J Heart Lung Transplant. 2006; 25: 1353-1357
- A right ventricular pressure waveform based pulse contour cardiac output algorithm in canines.Cardiovasc Eng. 2006; 6: 83-92
- Right ventricular pressure waveform and wave reflection analysis in patients with pulmonary arterial hypertension.Chest. 2007; 132: 37-43
Article info
Publication history
Published online: June 03, 2008
Accepted:
April 21,
2008
Received in revised form:
April 9,
2008
Received:
January 9,
2008
Footnotes
Conflicts of interest: R.P.F., R.L.B., R.C.B., R.J.B. and M.D.M. have received research support from Medtronic, Inc. B.K. and T.D.B. are employees of Medtronic, Inc.
Identification
Copyright
© 2008 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
