Effects of pressure variation and atrial fibrillation on CardioMEMS™ HF measured pulmonary artery diastolic pressure: comparison of device-averaged and visually inspected waveforms. (11th May 2017)

• Record Type: Journal Article
• Authors: Wolfson, Aaron M; Yousefian, Omid; Short, Lindsay; O'Brien, Daniel; Talmor, Guy; Qiu, Jessica; Yoon, Andrew; Fong, Michael; Saxon, Leslie; Doshi, Rahul; Grazette, Luanda; Shavelle, David M
• Is Part Of: Physiological measurement. Volume 38:Number 6(2017:Jun.)
• Page Start: 1094
• Page End: 1103
• Publication Date: 2017-05-11
• Subjects: congestive heart failure -- remote hemodynamic monitoring -- hemodynamics -- implantable devices; Physiology -- Measurement -- Periodicals; Patient monitoring -- Periodicals; 612
• DOI: 10.1088/1361-6579/aa6edb
• Languages: English
• ISSNs: 0967-3334

Abstract

Abstract: Objective: Heart failure (HF) management guided by implantable hemodynamic monitoring reduces hospitalization rates. Hemodynamic data from the CardioMEMS ™ HF system includes device-averaged pulmonary artery pressures (PAP) and heart rate. Agreement of device-averaged values compared to the standard method of visual inspection of pressure waveforms at end-expiration is unknown. We evaluated the agreement between device-averaged and visually inspected end-expiratory PAP. Approach: Twenty-one patients implanted with the CardioMEMS ™ HF system were evaluated. Eight-hundred twenty-three PAP waveforms from the Merlin remote monitoring website were visually inspected and pulmonary artery systolic pressure (PASP) and pulmonary artery diastolic pressure (PADP) at end-expiration were recorded. Waveforms were evaluated for pressure variation (PV), defined as the difference between highest and lowest PASP measurement of ⩾20 mmHg. Bland-Altman analysis quantified differences between device-averaged and visually inspected waveforms. Main Results: All patients were NYHA functional class III, mean age was 67 ± 15 years and 15 (71%) had AF. Bland–Altman analysis of all waveforms revealed a mean-difference in PADP of −1.4 mmHg, indicating that visually inspected values were higher than device-averaged values. For PV ⩾20 mmHg, this value increased to −2.8 mmHg. The mean-difference comparing waveforms from patients with or without AF was −1.3 and −1.6 mmHg, respectively. The 95% limits of agreement were >50% wider for waveforms from patients with versus without AF (10.3 versus 6.7 mmHg). Significance: There is good agreement between device-averaged and visually inspected waveforms when pressure variation is <20 mmHg and for patients without atrial fibrillation.