Morbidity and mortality in heart failure (HF) remain high despite contemporary therapy, especially in patients with concomitant pulmonary hypertension (PH). RHC is used to risk stratify patients with HF and to determine the etiology and severity of PH. However, implantable hemodynamic monitors (IHM) can provide ongoing hemodynamic data which affords the opportunity for optimal medical management of HF patients with PH.
We retrospectively analyzed data from the CHAMPION trial of a wireless IHM in 550 NYHA class III HF patients, regardless of HF etiology or LVEF. Comparison was made between a WHO Group II PH cohort (defined as mPAP>25mmHg) and non-PH cohort (mPAP<25mmHg). Among PH patients, HF hospitalizations and mortality were compared in patients in the treatment and control arms and in subgroups stratified by PVR and TPG.
314 patients (59%) (151 treatment vs. 163 control) had WHO Group II PH. PH patients had lower LVEF (28% vs. 31%, P=0.0042), significantly higher PCWP (23 vs. 12 mmHg, P<0.0001), lower cardiac index (2.1 vs. 2.3 L/min/m2, P=0.001) and higher PVR (3.4 vs. 1.9 WU, P<0.0010). PH patients more frequently had CAD (74% vs. 65%, P=0.04) and history of atrial arrhythmias (52% vs. 39%, P=0.0059). PH patients had higher hospitalization rates than non-PH patients (0.77/yr vs. 0.37/yr, HR 0.49, 95%CI 0.39-0.61). Hospitalization rates were highest for patients with PH in the control arm of the study (0.94/yr) and lowest in patients without PH in the treatment arm (0.28/yr). In patients with and without PH, ongoing knowledge of IHM data resulted in a significant reduction in HF hospitalization (HR 0.64, 95%CI 0.51-0.81 for PH patients) and (HR 0.60, 95%CI 0.41-0.89 for non-PH). Hospitalization rates were highest in patients with TPG>15mm Hg (0.99/yr) and PVR>3 WU (1.11/yr) in the control group. Though the treatment group consistently had lower hospitalization rates than controls across PH subgroups, relative risk reduction was lowest in patients with TPG>15 mmHg (RRR 30%) and PVR>3 WU (RRR 33%). Among PH patients, there was a non-significant trend towards improved survival with knowledge of IHM parameters (HR 0.78, 95% CI 0.50-1.22).
Ongoing knowledge of data from an IHM can lead to substantial reductions in hospitalizations across a broad cohort of WHO Group II PH patients.
© 2014 Published by Elsevier Inc.