Pulmonary Artery Pressure Monitoring Effectively Guides Management to Reduce Heart Failure Hospitalizations in Obesity

D. Marshall Brinkley, Maya E. Guglin, Mosi K. Bennett, Margaret M. Redfield, William T. Abraham, Marie Elena Brett, Nicholas Dirckx, Philip B. Adamson, Lynne W. Stevenson

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: This study sought to determine the impact of therapy guided by pulmonary artery (PA) pressure monitoring in patients with heart failure (HF) and obesity. Background: Obesity is prevalent in HF and associated with volume retention, but it complicates clinical assessment of congestion. Methods: The CardioMEMS Post Approval Study was a prospective, multicenter, open-label trial in 1,200 patients with New York Heart Association functional class III HF and prior HF hospitalization (HFH) within 12 months. Patients with a body mass index (BMI) >35 kg/m2 were required to have a chest circumference <65 inches. Therapy was guided by PA pressure monitoring at sites, and HFHs were adjudicated 1 year before implantation and throughout follow-up. This analysis stratified patients according to ejection fraction (EF) <40% or ≥40% and by BMI <35 kg/m2 or ≥35 kg/m2. Results: Baseline PA diastolic pressure was higher in patients with BMI ≥35 kg/m2 regardless of EF, but all PA pressures were reduced at 12 months in each cohort (P < 0.0001). HFH rate was reduced by >50% in both cohorts for EF <40% (BMI <35 kg/m2 [HR: 0.48; 95% CI: 0.41-0.55] and ≥35 kg/m2 [HR: 0.40; 95% CI: 0.31-0.53]) and EF ≥40% (BMI <35 kg/m2 [HR: 0.42; 95% CI: 0.35-0.52] and ≥35 kg/m2 [HR: 0.34; 95% CI: 0.25-0.45]; P < 0.0001). There was a nonsignificant trend toward greater reduction with more obesity. The all-cause hospitalization rate was also significantly reduced during monitoring (P < 0.01). Conclusions: Management guided by PA pressure monitoring effectively reduced pressures, HFH, and all-cause hospitalization in patients with obesity regardless of EF. (CardioMEMS HF System Post Approval Study; NCT02279888)

Original languageEnglish (US)
Pages (from-to)784-794
Number of pages11
JournalJACC: Heart Failure
Volume9
Issue number11
DOIs
StatePublished - Nov 2021

Keywords

  • heart failure
  • hemodynamics
  • obesity
  • pulmonary artery pressure-guided therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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