A 3-Year Single Center Experience With Left Atrial Pressure Remote Monitoring: The Long and Winding Road

Frontiers in Cardiovascular Medicine

article

Attilio Restivo¹  Domenico D'Amario¹  Donato Antonio Paglianiti¹  Renzo Laborante¹  Giuseppe Princi¹  Luigi Cappannoli¹  Antonio Iaconelli¹  Mattia Galli¹  Nadia Aspromonte¹  Gabriella Locorotondo¹  Francesco Burzotta¹  Carlo Trani¹  Filippo Crea¹ 

[1] Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart;Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS;Department of Cardiology, Maria Cecilia Hospital, GVM Care and Research

关键词: heart failure;    hemodynamic remote monitoring;    device in heart failure;    digital health;    telemonitoring;    remote care technologies;   

DOI  :  10.3389/fcvm.2022.899656

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Despite continuous advancement in the field, heart failure (HF) remains the leading cause of hospitalization among the elderly and the overall first cause of hospital readmission in developed countries. Implantable hemodynamic monitoring is being tested to anticipate the clinical exacerbation onset, potentially preventing an emergent acute decompensation. To date, only pulmonary artery pressure (PAP) sensor received the approval to be implanted in symptomatic heart failure patients with reduced ejection fraction. However, PAP's indirect estimation of left ventricular filling pressure can be inaccurate in some contexts. Methods The VECTOR-HF study ( NCT03775161 ) is examining the safety, usability and performance of the V-LAP system, a latest-generation device capable of continuously monitoring left atrial pressure (LAP). In our center, five advanced HF patients have been enrolled. After confirmation of the transmitted data reliability, LAP trends and waveforms have guided therapy optimization. The aim of this work is to share clinical insights from our center preliminary experience with V-LAP application. Results Over a median follow-up time of 18 months, LAP–based therapy optimization managed to reduce intracardiac pressure over time and no hospital readmission occurred. This result was paralleled by an improvement in both functional capacity (6MWT distance 352.5 ± 86.2 meters at baseline to 441.2 ± 125.2 meters at last follow-up) and quality of life indicators (KCCQ overall score 63.82 ± 16.36 vs. 81.92 ± 9.63; clinical score 68.47 ± 19.48 vs. 83.70 ± 15.58). Conclusion Preliminary evidence from V-LAP application at our institution support a promising efficacy. However, further study is needed to confirm the technical reliability of the device and to exploit the clinical benefit of left-sided hemodynamic remote monitoring.

【 授权许可】

CC BY