Remote evaluation of risk and physiological response to therapeutic escalation and clinical worsening in patients with pulmonary hypertension
Remote evaluation of risk and physiological response to therapeutic escalation and clinical worsening in patients with pulmonary hypertension
复制标题
肺动脉高压患者治疗升级和临床恶化的风险和生理反应的远程评估
DOI：
10.1101/2023.04.27.23289153
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Middleton J
中科院分区：
文献类型：
--
作者：
Middleton J
背景国际指南建议定期进行以医院为基础的危险分层，以帮助评估和管理肺动脉高压患者。技术进步使得能够每天远程测量心肺生理学和身体活动，这有可能提供治疗效果的早期评估，并促进基于临床事件之前的生理变化的早期干预。我们试图调查远程监测参数和COMPERA 2.0 4层风险评分之间的关系，并评估治疗升级后和临床恶化events.MethodsEighty-seven肺动脉高压患者的生理变化植入可插入的心脏监护仪，包括一套28例患者也植入了肺动脉压力监测。采用4层COMPERA 2.0风险评分评价医院测量和远程监测的生理参数。进行了一项时间分层双向病例交叉研究，以评价植入可插入心脏和肺动脉压力监测仪的嵌套组中治疗递增时的生理变化和临床恶化事件。远程生理风险的一个汇总措施计算的总和的Z-得分的身体活动，心率储备和总肺阻力和应用到远程monitoringdata.ResultsInsertable心脏监测测量的身体活动，心率变异性和心率储备下降，夜间心率增加COMPERA 2.0评分的患者（P<0.0001）。每日体力活动与增加穿梭步行距离相关（p<0.0001），但与6分钟步行距离无关。在治疗升级后，平均肺动脉压和总肺阻力分别在7、4、22和42天降低，心输出量和体力活动分别增加（p<0.05）。临床恶化事件发生之前，平均肺动脉压和总肺阻力增加，心输出量和体力活动减少（p<0.05）。将远程生理风险评分应用于远程监测数据表明，在临床指示的治疗增加后，在第三天可识别生理风险的降低，并且在临床恶化事件之前，在第一天，16.结论：获批器械可准确识别肺动脉高压患者在强化治疗后和治疗前的生理变化。临床恶化。血流动力学和心脏监测的远程评估可以促进个性化，积极主动的医学和创新的临床研究designs.Condensed Abstractechnological进步提供了远程测量心肺生理学的能力。在87例植入心脏监护仪的患者和嵌套组28例植入肺动脉压力监护仪的肺动脉高压患者中，在治疗升级和之前的临床恶化事件后观察到心肺功能和体力活动显著改善。该研究强调了远程监测在肺动脉高压患者个性化管理、早期治疗评估和创新临床试验设计方面的潜力。Twitter（X）post#PHPEEPS远程监测显示，治疗调整后仅7天心肺功能改善，事件恶化前12天出现不良变化。个性化护理的未来？学习...
BackgroundInternational guidelines recommend regular, hospital-based risk stratification to aid assessment and management of patients with pulmonary arterial hypertension. Technological advances enable daily, remote measurement of cardiopulmonary physiology and physical activity that have the potential to provide early evaluation of therapeutic efficacy and facilitate early intervention based on the physiological changes that precede clinical events. We sought to investigate the relationship between remote-monitored parameters and the COMPERA 2.0 4-strata risk score and evaluate physiological changes following therapeutic escalation and prior to clinical worsening events.MethodsEighty-seven patients with pulmonary arterial hypertension were implanted with insertable cardiac monitors including a nested set of twenty-eight patients also implanted with a pulmonary artery pressure monitor. Hospital measured and remote monitored physiological parameters were evaluated by 4-strata COMPERA 2.0 risk score. A time stratified bidirectional case-crossover study was undertaken to evaluate physiological changes at the time of therapy escalation and clinical worsening events in the nested group with insertable cardiac and pulmonary artery pressure monitors. A summary measure of remote physiological risk was calculated as the sum of the z-score of physical activity, heart rate reserve and total pulmonary resistance and applied to remote monitoring data.ResultsInsertable cardiac monitor-measured physical activity, heart rate variability and heart rate reserve were decreased and night heart rate increased in patients with increasing COMPERA 2.0 score (p<0.0001). Daily physical activity was related to incremental shuttle walk distance (p<0.0001) but not six-minute walk distance. Following therapeutic escalation mean pulmonary artery pressure and total pulmonary resistance were reduced and cardiac output, and physical activity increased at 7, 4, 22, and 42 days, respectively (p<0.05). Clinical worsening events were preceded by increased mean pulmonary artery pressure and total pulmonary resistance, reduced cardiac output and physical activity (p<0.05). Applying a remote physiological risk score to remote-monitored data demonstrated that following a clinically indicated increase in therapy, a reduction in physiological risk was identifiable at day three, and preceding a clinical worsening event, an increase in adverse physiology was observable at day - 16.ConclusionApproved devices accurately identify change in physiology in patients with pulmonary arterial hypertension following therapeutic intensification and before clinical worsening. A remote assessment of haemodynamic and cardiac monitoring may facilitate personalised, proactive medicine and innovative clinical study designs.Condensed AbstractTechnological advances provide the capacity to remotely measure cardiopulmonary physiology. In 87 patients with insertable cardiac monitors and a nested group 28 patients with pulmonary arterial hypertension implanted with pulmonary artery pressure monitors, significant improvements in cardiopulmonary function and physical activity were observed following therapeutic escalation and preceding clinical worsening events. The study highlights the potential of remote monitoring for personalised management, early therapeutic evaluation, and innovative clinical trial designs in patients with pulmonary hypertension.Twitter (X) post#PHPEEPS Remote monitoring shows improved cardiopulmonary function just 7 days after therapy adjustments, and adverse changes 12 days before a worsening event. The future of personalised care?Learning …
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影响因子：
9.7
作者：
Conraads, Viviane M.;Spruit, Martijn A.;van Veldhuisen, Dirk J.
通讯作者：
van Veldhuisen, Dirk J.
影响因子：
39.3
作者：
Bonnesen MP;Frodi DM;Haugan KJ;Kronborg C;Graff C;Højberg S;Køber L;Krieger D;Brandes A;Svendsen JH;Diederichsen SZ
通讯作者：
Diederichsen SZ
DOI：
10.1183/13993003.02311-2021
发表时间：
2022-07
期刊：
The European respiratory journal
影响因子：
--
作者：
通讯作者：
--
影响因子：
24.3
作者：
Hurdman, J.;Condliffe, R.;Kiely, D. G.
通讯作者：
Kiely, D. G.
影响因子：
158.5
作者：
Pulido, Tomas;Adzerikho, Igor;Simonneau, Gerald
通讯作者：
Simonneau, Gerald