Assmus Birgit, Angermann Christiane E, Alkhlout Basil, Asselbergs Folkert W, Schnupp Steffen, Brugts Jasper J, Nordbeck Peter, Zhou Qian, Brett Marie-Elena, Ginn Greg, Adamson Philip B, Böhm Michael, Rosenkranz Stephan
Cardiology, Department of Medicine, Goethe University Hospital, Frankfurt, Germany.
Medical Clinic I, Department of Cardiology, University Hospital Giessen, Justus Liebig University Giessen, Giessen, Germany.
Eur J Heart Fail. 2022 Dec;24(12):2320-2330. doi: 10.1002/ejhf.2656. Epub 2022 Nov 3.
The CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF) investigated safety and efficacy of pulmonary artery pressure (PAP)-guided remote patient management (RPM) in New York Heart Association (NYHA) class III outpatients with at least one heart failure hospitalization (HFH) during the previous 12 months. This pre-specified subgroup analysis investigated whether RPM effects depended on presence and subtype of pulmonary hypertension (PH).
In 106/234 MEMS-HF participants, Swan-Ganz catheter tracings obtained during sensor implant were available for off-line manual analysis jointly performed by two experts. Patients were classified into subgroups according to current PH definitions. Isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH) were present in 38 and 36 patients, respectively, whereas 31 patients had no PH. Clinical characteristics were comparable between subgroups, but among patients with PH pulmonary vascular resistance was higher (p = 0.029) and pulmonary artery compliance lower (p = 0.003) in patients with CpcPH. During 12 months of PAP-guided RPM, all PAPs declined in IpcPH and CpcPH subgroups (all p < 0.05), whereas only mean and diastolic PAP decreased in patients without PH (both p < 0.05). Improvements in post- versus pre-implant HFH rates were similar in CpcPH (0.639 events/patient-year; hazard ratio [HR] 0.37) and IpcPH (0.72 events/patient-year; HR 0.45) patients. Participants without PH benefited most (0.26 events/patient-year; HR 0.17, p = 0.04 vs. IpcPH/CpcPH patients). Quality of life and NYHA class improved significantly in all subgroups.
Outpatients with NYHA class III symptoms with at least one HFH during 1 year pre-implant benefitted significantly from PAP-guided RPM during post-implant follow-up irrespective of presence or subtype of PH at baseline.
欧洲心力衰竭心脏微机电系统监测研究（MEMS-HF）探讨了肺动脉压（PAP）引导的远程患者管理（RPM）在纽约心脏协会（NYHA）III级门诊患者中的安全性和有效性，这些患者在过去12个月内至少有一次心力衰竭住院（HFH）。这项预先设定的亚组分析研究了RPM的效果是否取决于肺动脉高压（PH）的存在及其亚型。
在106/234名MEMS-HF参与者中，传感器植入期间获得的Swan-Ganz导管记录可供两位专家联合进行离线人工分析。根据当前的PH定义将患者分为亚组。分别有38例和36例患者存在单纯毛细血管后PH（IpcPH）和毛细血管后与毛细血管前联合PH（CpcPH），而31例患者无PH。各亚组间临床特征具有可比性，但在有PH的患者中，CpcPH患者的肺血管阻力更高（p = 0.029），肺动脉顺应性更低（p = 0.003）。在PAP引导的RPM的12个月期间，IpcPH和CpcPH亚组的所有PAP均下降（所有p < 0.05），而无PH的患者仅平均PAP和舒张期PAP下降（两者p < 0.05）。CpcPH（0.639次事件/患者年；风险比[HR] 0.37）和IpcPH（0.72次事件/患者年；HR 0.45）患者植入后与植入前HFH发生率的改善相似。无PH的参与者获益最大（0.26次事件/患者年；HR 0.17，与IpcPH/CpcPH患者相比，p = 0.04）。所有亚组的生活质量和NYHA分级均显著改善。
植入前1年内有至少一次HFH的NYHA III级症状门诊患者，在植入后随访期间，无论基线时是否存在PH及其亚型，均从PAP引导的RPM中显著获益。
