Variation in CardioMEMS Pressure Measurements Due to Frequent Changes in Altitude in a Patient with HeartMate III LVAD

Autor: Gregory P. Milligan, A. Hamadeh, Amit Alam, Daniel Cheeran, S. Joseph, Shelley A. Hall, Sanjay K. Banerjee, N. Minniefield
Rok vydání: 2021
Předmět:
Zdroj: The Journal of Heart and Lung Transplantation. 40:S491
ISSN: 1053-2498
DOI: 10.1016/j.healun.2021.01.2010
Popis: Introduction Implantation of a wireless pulmonary artery pressure monitoring device [CardioMEMS] has been utilized to monitor hemodynamic parameters in patients with NYHA Class III heart failure, however the impact of travel between altitudes on device calibration in patients who have received the Heart Mate III (HM3) Left Ventricular Assist Device (LVAD) is unknown. We describe a case of poorly correlating CardioMEMS readings with Swan-Ganz catheter measurements in a patient requiring frequent travel. Case Report A 53 year old man underwent placement of a CardioMEMS device 4 months prior to placement of a HM3 LVAD for stage D non-ischemic cardiomyopathy and was noted to have significant increases in the device's pulmonary arterial pressure readings. The patient was clinically stable and well compensated with stable LVAD settings and no alarms were noted. His chest X-ray showed stable position of his CardioMEMS device, clear lung fields, and a stable LVAD device position. Pulmonary artery waveform on the CardioMEMS device was normal. Repeat right heart catheterization at his home institution showed significant discrepancy between Swan-Ganz catheter measurements and his CardioMEMS readings. The difference in mean pulmonary artery pressure was roughly 15 mmHg. The device had been auto-calibrated at a different institution that was 3996 ft (1217 m) higher in altitude. The patientʼs travel between institutions continued due to active transplant evaluation and the CardioMEMS auto re-calibrated to the higher altitude setting despite recalibration twice at the home institution. The decision was made to turn off his CardioMEMS and monitor the patient clinically. Summary CardioMEMS device implantation can assist in remote monitoring of heart failure patients with LVADs. Accuracy of the device may be affected by large changes in elevation between the initial baseline calibration and subsequent measurements (2mm Hg per 305 meters elevation change) in patients without an LVAD per the device manufacturer. This case highlights the importance of considering changes in elevation of different geographic calibration locations as potential causes for error in CardioMEMS pressure readings prior to adjustment of medications. Further investigation is needed to evaluate changes in CardioMEMS pressure readings as it correlates to changes in altitude in LVAD patients.
Databáze: OpenAIRE
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