Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wroclaw Medical University, Wrocław, Poland.
Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Wrocław, Poland.
Sci Rep. 2024 Jun 5;14(1):12929. doi: 10.1038/s41598-024-63742-0.
Heart failure (HF) poses a significant challenge, often leading to frequent hospitalizations and compromised quality of life. Continuous pulmonary artery pressure (PAP) monitoring offers a surrogate for congestion status in ambulatory HF care. This meta-analysis examines the efficacy of PAP monitoring devices (CardioMEMS and Chronicle) in preventing adverse outcomes in HF patients, addressing gaps in prior randomized controlled trials (RCTs). Five RCTs (2572 participants) were systematically reviewed. PAP monitoring significantly reduced HF-related hospitalizations (RR 0.72 [95% CI 0.6-0.87], p = 0.0006) and HF events (RR 0.86 [95% CI 0.75-0.99], p = 0.03), with no impact on all-cause or cardiovascular mortality. Subgroup analyses highlighted the significance of CardioMEMS and blinded studies. Meta-regression indicated a correlation between prolonged follow-up and increased reduction in HF hospitalizations. The risk of bias was generally high, with evidence certainty ranging from low to moderate. PAP monitoring devices exhibit promise in diminishing HF hospitalizations and events, especially in CardioMEMS and blinded studies. However, their influence on mortality remains inconclusive. Further research, considering diverse patient populations and intervention strategies with extended follow-up, is crucial for elucidating the optimal role of PAP monitoring in HF management.
心力衰竭（HF）是一个重大挑战，常导致频繁住院和生活质量受损。连续肺动脉压（PAP）监测可作为HF 患者门诊治疗充血状态的替代指标。本荟萃分析旨在探讨 PAP 监测设备（CardioMEMS 和 Chronicle）在预防 HF 患者不良结局方面的疗效，以解决先前随机对照试验（RCT）中的空白。系统性回顾了 5 项 RCT（2572 名参与者）。PAP 监测显著降低了 HF 相关住院率（RR 0.72 [95% CI 0.6-0.87]，p=0.0006）和 HF 事件发生率（RR 0.86 [95% CI 0.75-0.99]，p=0.03），但对全因或心血管死亡率无影响。亚组分析强调了 CardioMEMS 和盲法研究的重要性。Meta 回归表明，随访时间延长与 HF 住院率降低幅度增加之间存在相关性。总体偏倚风险较高，证据确定性从低到中等不等。PAP 监测设备在减少 HF 住院率和事件方面具有一定前景，尤其是在 CardioMEMS 和盲法研究中。然而，其对死亡率的影响仍不确定。进一步研究需要考虑不同患者人群和干预策略，以及延长随访时间，以明确 PAP 监测在 HF 管理中的最佳作用。
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