HFSA ePoster Library

Background: Reverse remodeling of the heart is the goal of neurohormonal blockade in HF. While hemodynamic unloading with LVADs have shown a similar concept, it is not known if prolonged normalization of LV filling pressures with guidance of a remote PA pressure monitoring device like CardioMEMS is associated with reverse remodeling of the heart. We evaluated if patients with CardioMEMS and reduction in PA pressures have echocardiographic (ECHO) parameters of reverse remodeling.
Methods: ECHO parameters of LV size (LVIDd, LVIDs, LVEDV, LVESV), RV size (RVEDA, RVESA, RVFAC), LVEF, and LV diastology (LAV, E, A and E/A, e’, a’, TR velocity and pulmonary artery pressure) were obtained prior to CardioMEMS implant and at 6, 12, and 18 months post implant in 34 patients (mean age 61 years) in the Houston Methodist HF remote monitoring program. PA pressures from the CardioMEMS device were obtained at the respective time points. Baseline data on demographics, medications, and laboratories were obtained on all patients. Linear mixed modeling was used to assess the mean change over time of the repeatedly measured ECHO parameters and PA pressures from baseline to 18 months after implantation. Adjusted means or coefficient (and 95% confidence interval) were used to assess the changes of each ECHO parameter and PA pressure from baseline to 18 months. All the analyses were performed on Stata version 16.1 (StataCorp LLC, College Station, TX, USA). A p-value of <0.05 was considered statistically significant.
Results: The baseline LVEF was <30% in 50% of patients. Median baseline LVIDd was 56 mm, median LVIDs was 47 mm, median indexed LA volume was 73.5 mL, and median PA systolic, diastolic and mean pressures were 39 mmHg, 20 mmHg, and 27 mmHg, respectively. At 18 months, median LVIDd decreased to 49 mm (-6.73, CI: -12.44 to -1.02, p=0.02), LVIDs decreased to 40 mm (-6.83, CI: -13.07 to -0.58, p= 0.03), and indexed LA volume decreased to (-6.12, CI: -12.4 to 0.17, p= 0.06) with concomitant decreases in PA systolic (-3.99, CI: -7.74 to -0.25, p= 0.04), diastolic (-3.70, CI: -6.37 to -1.04, p= 0.01) and mean pressures (-3.44, CI: -6.35 to 0.53, p= 0.02), respectively (Figure-1). No significant differences in LVEF, RV size and LV diastolic parameters were noted.
Conclusions: In patients with HF, pressure-guided management with CardioMEMS system with resultant sustained decrease in PA pressures is associated with a significant decrease in LV dimensions and trend toward significant decrease in LA volume based on ECHO.