Pulmonary Artery Pressure Monitoring Effectively Guides Management to Reduce Heart Failure Hospitalizations in Obesity.
| Autor: | Brinkley DM; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: marshall.brinkley@vumc.org., Guglin ME; Indiana University School of Medicine, Krannert Institute of Cardiology, Avon, Indiana, USA., Bennett MK; Minneapolis Heart Institute, Minneapolis, Minnesota, USA., Redfield MM; Mayo Clinic, Rochester, Minnesota, USA., Abraham WT; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA., Brett ME; Abbott, Atlanta, Georgia, USA., Dirckx N; Abbott, Atlanta, Georgia, USA., Adamson PB; Abbott, Atlanta, Georgia, USA., Stevenson LW; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. |
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| Jazyk: | angličtina |
| Zdroj: | JACC. Heart failure [JACC Heart Fail] 2021 Nov; Vol. 9 (11), pp. 784-794. Date of Electronic Publication: 2021 Sep 08. |
| DOI: | 10.1016/j.jchf.2021.05.020 |
| Abstrakt: | Objectives: This study sought to determine the impact of therapy guided by pulmonary artery (PA) pressure monitoring in patients with heart failure (HF) and obesity. Background: Obesity is prevalent in HF and associated with volume retention, but it complicates clinical assessment of congestion. Methods: The CardioMEMS Post Approval Study was a prospective, multicenter, open-label trial in 1,200 patients with New York Heart Association functional class III HF and prior HF hospitalization (HFH) within 12 months. Patients with a body mass index (BMI) >35 kg/m 2 were required to have a chest circumference <65 inches. Therapy was guided by PA pressure monitoring at sites, and HFHs were adjudicated 1 year before implantation and throughout follow-up. This analysis stratified patients according to ejection fraction (EF) <40% or ≥40% and by BMI <35 kg/m 2 or ≥35 kg/m 2 . Results: Baseline PA diastolic pressure was higher in patients with BMI ≥35 kg/m 2 regardless of EF, but all PA pressures were reduced at 12 months in each cohort (P < 0.0001). HFH rate was reduced by >50% in both cohorts for EF <40% (BMI <35 kg/m 2 [HR: 0.48; 95% CI: 0.41-0.55] and ≥35 kg/m 2 [HR: 0.40; 95% CI: 0.31-0.53]) and EF ≥40% (BMI <35 kg/m 2 [HR: 0.42; 95% CI: 0.35-0.52] and ≥35 kg/m 2 [HR: 0.34; 95% CI: 0.25-0.45]; P < 0.0001). There was a nonsignificant trend toward greater reduction with more obesity. The all-cause hospitalization rate was also significantly reduced during monitoring (P < 0.01). Conclusions: Management guided by PA pressure monitoring effectively reduced pressures, HFH, and all-cause hospitalization in patients with obesity regardless of EF. (CardioMEMS HF System Post Approval Study; NCT02279888). Competing Interests: Funding Support and Author Disclosures Data analysis and funding for the CardioMEMS Post-Approval Study were provided by Abbott. Dr Brinkley has received fees from scPharmaceuticals and VoluMetrix, outside the submitted work. Dr Stevenson has received unreimbursed consultation to Abbott outside the submitted work. Dr Bennett has received fees from Abbott outside the submitted work. Dr Abraham has received fees from Abbott early in the course of this study. Drs Brett, Dirckx, and Adamson are employed by Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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