Implanted Hemodynamic Monitoring in Patients With Fontan CirculationImplanted Hemodynamic Monitoring in Patients With Fontan Circulation https://pediatricsnationwide.org/wp-content/themes/corpus/images/empty/thumbnail.jpg 150 150 Mary Bates, PhD Mary Bates, PhD https://secure.gravatar.com/avatar/c6233ca2b7754ab7c4c820e14eb518c8?s=96&d=mm&r=g
- February 12, 2024
- Mary Bates, PhD
Pulmonary artery pressures obtained with the CardioMEMSTM system may be clinically useful.
In a new study, researchers from The Ohio State University and Nationwide Children’s Hospital report on the use of invasive implanted hemodynamic monitoring (IHM) in patients with Fontan circulation. The findings suggest that IHM pressures in these patients are more closely associated with mortality and liver function than pressures measured by cardiac catheterization.
In patients with Fontan circulation, measures of central venous pressure are important for guiding classification, management and prognosis. However, obtaining these measures over time requires repeat cardiac catheterizations, and the pressures obtained do not represent hemodynamics during real-life activities.
IHM using the CardioMEMSTM HF system is an alternative method that allows for serial, noninvasive assessment of pulmonary artery pressures in non-fasting, non-sedated patients. The system has been shown to reduce heart failure hospitalizations in patients with acquired heart failure, but is less studied in patients with congenital disease, says study lead author William Marshall, MD, an assistant professor of internal medicine at The Ohio State University and Nationwide Children’s.
“We are probably the largest program in the country to utilize IHM with CardioMEMS in congenital heart disease patients, and specifically in patients with Fontan circulation,” he says. “One of our goals with this study was to share our experience to help other programs that are starting to use it.”
Dr. Marshall and colleagues conducted a retrospective study of 18 patients with Fontan circulation referred for IHM placement at their center from 2015 to 2022. In this cohort with relatively advanced Fontan circulatory failure, IHM did not reduce heart failure hospitalizations, though this may have been limited by low patient adherence to transmission and the small sample size.
The researchers also found that IHM pressures were better associated with liver disease (measured by the Model for End‐Stage Liver Disease Excluding International Normalized Ratio score) and mortality than pressures obtained with cardiac catheterization. This suggests that IHM pressures could be more sensitive in predicting clinical outcomes or guiding treatment decisions, says study senior author Curt Daniels, MD, professor of internal medicine and pediatrics and director of the Columbus Ohio Adult Congenital Heart Disease (COACH) Program at Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center.
Drs. Marshall and Daniels and team also recently reported on their use of IHM with the CardioMEMSTM system in another population of congenital heart disease patients, adults with failing subaortic right ventricles. In these patients, who are at risk for developing pulmonary hypertension which can limit their options for future cardiac transplant, the researchers say IHM may obviate the need for repeated cardiac catheterizations and help guide treatment.
“Because of their unique anatomy and physiology, it is challenging to obtain regular, accurate data from these patients, but knowing hemodynamics guides our use of advanced heart failure therapies and timing for heart transplant,” says Dr. Daniels, who is also an associate professor in pediatrics and pediatric cardiology at The Ohio State University. “We have found that IHM is an innovative way to get important information to help manage patients.”
Marshall WH 5th, Rajpal S, Mah ML, Armstrong AK, Salavitabar A, Hickey J, Metzger R, Sisk T, Daniels CJ. Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation. Journal of the American Heart Association. 2023 Dec 8:e031836. doi: 10.1161/JAHA.123.031836. Epub ahead of print.
Marshall V WH, Mah ML, DeSalvo J, Rajpal S, Lastinger LT, Salavitabar A, Armstrong AK, Berman D, Lampert B, Wright LK, Hickey J, Metzger R, Nandi D, Gajarski R, Daniels CJ. Novel uses for implanted haemodynamic monitoring in adults with subaortic right ventricles. Heart. 2023 Nov 7:heartjnl-2023-323206. doi: 10.1136/heartjnl-2023-323206. Epub ahead of print.
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