Remote invasive monitoring of pulmonary artery pressures in heart failure patients: Initial experience in Portugal in the context of the Covid-19 pandemic

Resumo Introducao: A insuficiencia cardiaca (IC) descompensada esta associada a mau prognostico a curto e longo prazo. A monitorizacao remota invasiva da pressao na arteria pulmonar (PAP) possibilita a detecao precoce da descompensacao da IC, previamente ao inicio dos sintomas, podendo melhorar os resultados clinicos. Descrevemos a experiencia inicial com a utilizacao do sistema de monitorizacao remota CardioMEMS™ em doentes com IC, incluindo a sua seguranca e eficacia. Metodos e resultados: Foram incluidos prospectivamente, 5 doentes com IC em classe III da New York Heart Association, com pelo menos uma hospitalizacao por IC descompensada nos ultimos 12 meses, submetidos a implantacao de sistema de monitorizacao remota invasiva da PAP. A mediana de idades foi de 66.0 anos (intervalo interquartil [IIQ] 50.5–77.5 anos), 80.0% eram do sexo masculino e todos apresentavam IC com fracao de ejecao reduzida. O sensor de PAP foi colocado num ramo da arteria pulmonar esquerda em todos os doentes, nao tendo ocorrido complicacoes major. Durante o follow-up mediano de 40 dias (IIQ 40-61 dias), foram transmitidas um total de 271 leituras, verificando-se uma adesao dos doentes de 100% e taxa de transmissao bem sucedida de 98.1%. A PAP manteve-se dentro do objetivo em tres doentes durante o follow-up. Apesar de continuarem assintomaticos, dois doentes apresentaram valores das PAP acima do alvo. Foi realizado ajuste dietetico e da dose de diuretico, sem necessidade de visitas clinicas presenciais, objetivando-se uma reducao efetiva das PAP. Durante o seguimento, nao se registaram hospitalizacoes por IC ou obitos. Conclusao: A monitorizacao da IC guiada pela hemodinâmica demonstrou ser segura e eficaz, podendo assumir-se como uma ferramenta util no manejo de doentes com IC, particularmente no contexto da pandemia COVID-19, quando e desejavel uma reducao do numero de consultas presenciais hospitalares. Background: Decompensated heart failure (HF) is associated with poor short- and long-term prognosis. Remote invasive monitoring of pulmonary artery pressures (PAP) enables early detection of HF decompensation, before symptoms occur, and may improve clinical outcomes. We aimed to describe our initial experience with the use of the CardioMEMS™ remote monitoring system in patients with HF, including its safety and effectiveness. Methods and results: Five patients with HF in New York Heart Association class III and at least one hospitalization due to decompensated HF in last 12 months, who underwent invasive remote monitoring of PAP, were included in this prospective registry. The median age was 66.0 years (interquartile range [IQR] 50.5–77.5 years), 80.0% were men and all had HF with reduced ejection fraction. The pulmonary artery (PA) sensor was placed in a left PA branch in all patients and no major procedural complications occurred. In median follow-up of 40 days (IQR 40–61 days), a total of 271 pressure readings were transmitted, patient compliance was 100% and freedom from sensor failure 98.1%. In three patients, PAP remained within the goal during follow-up. Two patients presented an increase in PAP to values above the targets, despite the absence of symptoms worsening. These required dietary and diuretic dose adjustment, without the need for outpatient clinic visits, which reduced PAP. No hospitalizations for HF or deaths occurred during follow-up. Conclusion: Hemodynamic-guided HF monitoring was safe and effective and may be a useful adjunctive tool to the standard-of-care management in selected HF patients, particularly in the context of the COVID-19 pandemic, where a reduction in the number of health care visits may be desirable.