Relationship between remote, ambulatory pulmonary artery pressures, and all-cause mortality in patients with chronic heart failure

Authors

Michael R. Zile, Medical University of South Carolina, RJH Department of Veterans Affairs Health Care System, Charleston (M.R.Z.).
William T. Abraham, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (W.T.A., J.H.).
Lynne W. Stevenson, Advocate Health - Midwest
Maria Rosa Costanzo, Comprehensive Heart Failure Center, University and University Hospital, Würzburg, University Hospital Würzburg, Germany (M.R.C.).
Christiane E. Angermann, Center for Advanced Heart Disease, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA (C.E.A., M.R.M.).
Mandeep R. Mehra, Center for Advanced Heart Disease, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA (C.E.A., M.R.M.).
Akshay S. Desai, Montreal Heart Institute, Université de Montréal, Canada (A.S.D.).
Anique Ducharme, Abbott, IL (A.D., N.J.).
Nessa Johnson, Abbott, IL (A.D., N.J.).
John Henderson, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (W.T.A., J.H.).
JoAnn Lindenfeld

Recommended Citation

Zile MR, Abraham WT, Stevenson LW, et al. Relationship Between Remote, Ambulatory Pulmonary Artery Pressures, and All-Cause Mortality in Patients With Chronic Heart Failure. Circ Heart Fail. Published online April 14, 2025. doi:10.1161/CIRCHEARTFAILURE.124.012754

Affiliations

Advocate Heart Institute, Naperville

Abstract

Background:Hemodynamically guided management of patients with chronic heart failure (HF), using a remote, ambulatory pulmonary artery (PA) pressure monitor, has been shown to reduce mortality and morbidity. These improved outcomes were associated with a reduction in PA pressure. However, several pivotal questions remain unanswered: do systolic, diastolic, or mean PA pressures each predict all-cause mortality? Do PA pressures predict mortality across the ejection fraction (EF) spectrum? Do increases or decreases in PA pressure over time predict increases or decreases in mortality?

Methods:Retrospective analyses of data from CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients; n=550), GUIDE-HF (Hemodynamic-GUIDEed management of Heart Failure; n=2358), US PAS (CardioMEMS HF System Post Approval Study; n=1200), and MEMS-HF (CardioMEMS Monitoring Study for Heart Failure; n=234) were performed, including all enrolled patients regardless of treatment assignments (Total N=4342). PA systolic, PA diastolic, and PA mean pressures were examined in patients with HF and reduced EF (<50%, n=2562) and preserved EF (≥50%, n=1454). Baseline pressure (averaged over 14 days after implantation) and change in pressure (increase/decrease/no change) from baseline to 6 months (averaged over 14 days just before the 6-month time point) were related to all-cause mortality over a 2-year follow-up period.

Results:Baseline PA diastolic, independent of other covariates, was a significant predictor of mortality (hazard ratio, 1.04 [95% CI, 1.03-1.05]; P<0.0001). Change in PA diastolic from baseline to 6 months (assessed as a continuous variable) was an independent predictor of mortality after 6 months (landmark analysis; hazard ratio, 1.03 [95% CI, 1.01-1.05]; P=0.0042). Change in PA diastolic from baseline to 6 months(assessed as a categorical variable) decrease or increase of >2 mm Hg compared with no change predicted a 14.7% decrease and 26.7% increase in mortality, respectively (P=0.0237). PA systolic and PA mean pressures in both HF with reduced EF and HF with preserved EF patients, for both baseline and change from baseline to 6 months, were also predictive of all-cause mortality.

Conclusions:Baseline PAP (systolic, diastolic, and mean) and change in PAP (systolic, diastolic, and mean) from baseline to 6 months were independent predictors of 2-year mortality in patients with chronic HF in both preserved and reduced EF.

Registration:URL: https://www.clinicaltrials.gov; Unique identifier: CHAMPION NCT00531661 . URL: https://www.clinicaltrials.gov; Unique identifier: GUIDE-HF NCT03387813 . URL: https://www.clinicaltrials.gov; Unique identifier: USPAS NCT02279888 . URL: https://www.clinicaltrials.gov; Unique identifier: MEMS-HF NCT02693691 .

Document Type

Article

PubMed ID

40223608