Ongoing right ventricular hemodynarnics in heart failure -: Clinical value of measurements derived from an implantable monitoring system
Ongoing right ventricular hemodynarnics in heart failure -: Clinical value of measurements derived from an implantable monitoring system
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DOI：
10.1016/s0735-1097(02)02896-6
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发表时间：
2003-02-19
影响因子：
24
通讯作者：
Bennett, T
中科院分区：
文献类型：
--
作者：
Adamson, PB;Magalski, A;Bennett, T
本研究探讨了心脏衰竭患者植入式血流动力学监测仪（IHM）连续测量右心室（RV）血流动力学信息的特点，背景血流动力学监测可能会改善慢性心力衰竭（CHF）患者的日常管理。人们对长期的特征知之甚少。CHF患者的血液动力学信息或这些信息如何与有意义的临床事件。方法32例CHF患者接受了类似于单导联起搏器的永久性RV IHM系统。连续9个月测量右心室收缩压和舒张压、心率和压力导数，而不将数据用于临床决策或患者管理。然后将数据提供给临床提供者，并对患者进行了17个月的随访。检查最佳容量、临床确定的容量超负荷加重和容量不足事件期间的压力特征。使用患者的历史controls.RESULTS长期RV压力测量结果有显着的变异性或最小的时间相关的变化，IHM对住院的影响进行了检查。在36次容量超负荷事件中，RV收缩压增加25 +/- 4%（p < 0.05），心率增加11 +/- 2%（p < 0.05）。9/12例事件在需要住院治疗的急性加重前4 - 2天发生压力升高。在使用IHM数据进行临床管理之前的住院率平均为1.08/患者年，在使用血流动力学数据后降低至0.47/患者年（降低57%，p < 0.01）。结论：IHM的长期动态血压测量可能有助于指导日常临床管理，对CHF住院有潜在的有利影响。（美国科尔心脏病学杂志2003;41：565-71）（C）2003年美国心脏病学会基金会。
OBJECTIVES This study examined the characteristics of continuously measured right ventricular (RV) hemodynamic information derived from an implantable hemodynamic monitor (IHM) in heart failure patients.BACKGROUND Hemodynamic monitoring might improve the day-to-day management of patients with chronic heart failure (CHF). Little is known about the characteristics of long-term. hemodynamic information in patients with CHF or how such information relates to meaningful clinical events.METHODS Thirty-two patients with CHF received a permanent RV IHM system similar to a single-lead pacemaker. Right ventricular systolic and diastolic pressures, heart rate, and pressure derivatives were continuously measured for nine months without using the data for clinical decision-making or management of patients. Data were then made available to clinical providers, and the patients were followed up for 17 months. Pressure characteristics during optimal volume, clinically determined volume-overload exacerbations, and volume depletion events were examined. The effect of IHM on hospitalizations was examined using the patients' historical controls.RESULTS Long-term RV pressure measurements had either marked variability or minimal time-related changes. During 36 volume-overload events, RV systolic pressures increased by 25 +/- 4% (p < 0.05) and heart rate increased by 11 +/- 2% (p < 0.05). Pressure increases occurred in 9 of 12 events 4 2 days before the exacerbations requiring hospitalization. Hospitalizations before using IHM data for clinical management averaged 1.08 per patient year and decreased to 0.47 per patient-year (57% reduction, p < 0.01) after hemodynamic data were used.CONCLUSIONS Long-term ambulatory pressure measurements from an IHM may be helpful in guiding day-to-day clinical management, with a potentially favorable impact on CHF hospitalizations. (J Am Coll Cardiol 2003;41:565-71) (C) 2003 by the American College of Cardiology Foundation.