Angullo-Gómez María, Robles-Mezcua Ainhoa, Becerra-Muñoz Víctor Manuel, García-Pinilla José Manuel
Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga-IBIMA, CIBERCV, Campus de Teatinos s/n, 29010 Málaga, España.
Eur Heart J Case Rep. 2022 Sep 30;6(10):ytac401. doi: 10.1093/ehjcr/ytac401. eCollection 2022 Oct.
Despite many recent advances in heart failure (HF) therapies, there remains an unmet need in patients with HF with preserved ejection fraction (HFpEF) for adequate treatment and follow-up, with the potential to reduce associated mortality and morbidity. Increased intracardiac and intrapulmonary pressures have been shown to precede the onset of symptoms of decompensated HF by several days or even weeks, so there have been several attempts to influence the prognosis of HF by monitoring through various methods. One of these is ambulatory pulmonary pressure monitoring to guide treatment in anticipation of decompensation.
We present the case of a 65-year-old woman with rheumatic valve disease and mechanical aortic and mitral prosthesis since 2003 and pacemaker since 2014, with development of severe tricuspid regurgitation in 2018 and with new valve implantation and multiple decompensations of HFpEF despite optimal medical treatment. Under follow-up in the Heart Failure Unit and after multiple unsuccessful treatment adjustments, it was decided to implant a pulmonary artery pressure monitoring device-CardioMEMS®-in order to optimize patient follow-up and treatment. The procedure was carried out without complications and early optimization of treatment was possible, resulting in a significant reduction in decompensations and admissions for HF.
Ambulatory pulmonary pressure monitoring is shown to be a safe and effective option to anticipate treatment of heart failure decompensation even with preserved left ventricular ejection fraction, with a significantly positive impact on hospital readmissions and consequent benefit on morbidity and mortality.
尽管近期心力衰竭（HF）治疗取得了许多进展，但射血分数保留的心力衰竭（HFpEF）患者在充分治疗和随访方面仍存在未满足的需求，这有可能降低相关的死亡率和发病率。心内和肺内压力升高已被证明在失代偿性HF症状出现前几天甚至几周就已出现，因此人们尝试通过各种方法进行监测以影响HF的预后。其中一种方法是动态肺压监测，以在预期失代偿时指导治疗。
我们报告一例65岁女性患者，自2003年起患有风湿性瓣膜病并植入机械主动脉瓣和二尖瓣假体，自2014年起植入起搏器，2018年出现严重三尖瓣反流，尽管接受了最佳药物治疗，但仍出现新的瓣膜植入和多次HFpEF失代偿。在心力衰竭病房进行随访并多次调整治疗未成功后，决定植入肺动脉压力监测装置——CardioMEMS®，以优化患者的随访和治疗。该操作无并发症，且能够早期优化治疗，从而显著减少了HF的失代偿和住院次数。
动态肺压监测被证明是一种安全有效的方法，即使对于左心室射血分数保留的患者，也能预测心力衰竭失代偿的治疗情况，对再次入院有显著的积极影响，进而对发病率和死亡率有益。
