University of Virginia Health System, Charlottesville, VA, USA.
Global Research and Development, St. Jude Medical, Sylmar, CA, USA.
Heart Lung Circ. 2021 Sep;30(9):1389-1396. doi: 10.1016/j.hlc.2021.03.004. Epub 2021 Jun 11.
Pulmonary artery proportional pulse pressure (PAPP) was recently shown to have prognostic value in heart failure (HF) with reduced ejection fraction (HFrEF) and pulmonary hypertension. We tested the hypothesis that PAPP would be predictive of adverse outcomes in patients with implantable pulmonary artery pressure monitor (CardioMEMS™ HF System, St. Jude Medical [now Abbott], Atlanta, GA, USA).
Survival analysis with Cox proportional hazards regression was used to evaluate all-cause deaths and HF hospitalisation (HFH) in CHAMPION trial patients who received treatment with the CardioMEMS device based on the PAPP.
Among 550 randomised patients, 274 had PAPP ≤ the median value of 0.583 while 276 had PAPP>0.583. Patients with PAPP≤0.583 (versus PAPP>0.583) had an increased risk of HFH (HR 1.40, 95% CI 1.16-1.68, p=0.0004) and experienced a significant 46% reduction in annualised risk of death with CardioMEMS treatment (HR 0.54, 95% CI 0.31-0.92) during 2-3 years of follow-up. This survival benefit was attributable to the treatment benefit in patients with HFrEF and PAPP≤0.583 (HR 0.50, 95% CI 0.28-0.90, p<0.05). Patients with PAPP>0.583 or HF with preserved EF (HFpEF) had no significant survival benefit with treatment (p>0.05).
Lower PAPP in HFrEF patients with CardioMEMS constitutes a higher mortality risk status. More studies are needed to understand clinical applications of PAPP in implantable pulmonary artery pressure monitors.
最近研究表明，肺动脉比例脉冲压（PAPP）在心衰（HF）伴射血分数降低（HFrEF）和肺动脉高压患者中具有预后价值。我们检验了假设，即 PAPP 可以预测植入式肺动脉压力监测器（CardioMEMS™ HF 系统，圣犹达医疗公司[现为雅培]，亚特兰大，佐治亚州，美国）患者的不良结局。
采用 Cox 比例风险回归生存分析评估 CHAMPION 试验中接受 CardioMEMS 治疗的患者的全因死亡和 HF 住院（HFH）情况，该患者的治疗依据是 PAPP。
在 550 名随机患者中，274 名患者的 PAPP≤中位数 0.583，276 名患者的 PAPP>0.583。PAPP≤0.583（vs. PAPP>0.583）的患者 HFH 风险增加（HR 1.40，95%CI 1.16-1.68，p=0.0004），在 2-3 年的随访中，CardioMEMS 治疗使年化死亡率显著降低 46%（HR 0.54，95%CI 0.31-0.92）。这种生存获益归因于 HFrEF 患者和 PAPP≤0.583 患者的治疗获益（HR 0.50，95%CI 0.28-0.90，p<0.05）。PAPP>0.583 或 HF 射血分数保留（HFpEF）患者的治疗没有显著的生存获益（p>0.05）。
CardioMEMS 患者的 HFrEF 患者中较低的 PAPP 构成更高的死亡率风险状态。需要更多的研究来了解植入式肺动脉压力监测器中 PAPP 的临床应用。
