부산대학교 도서관

Background Hospital-based assessment of haemodynamics, exercise capacity and right heart function/strain are used for risk-stratification to aid clinical decision making and guide treatment in patients with pulmonary arterial hypertension. Advances in haemodynamic and cardiac monitoring now provide the capacity to remotely measure physiological parameters that relate to mortality from a patient’s home. We sought to examine remote monitored physiology in the time preceding and following increase in standard of care therapy and clinical worsening events in patients with pulmonary arterial hypertension. Methods Between January 2020 and October 2021 22 patients with WHO functional class III PAH and a hospitalisation in the preceding year were implanted with a pulmonary artery pressure monitor (CardioMEMS, Abbott) and an insertable cardiac monitor (LinQ, Medtronic) (FITPH 19/YH/0354). Remote data and clinical events were reviewed in a multidisciplinary team identifying 18 increases in therapy and 13 worsening events. For each parameter baseline was set at the 30-days preceding the event and daily data analysed as change from baseline. Statistical significance was determined using Wilcoxon matched pairs and One-way ANOVA with Dunnett’s correction as appropriate. Results Following clinically indicated increase in therapy improvements in field walk test, WHO functional class and NT-proBNP were observed (p<0.05) with mean time to follow up of 5.1 months. Remote monitored mean pulmonary artery pressure and total pulmonary resistance were reduced and cardiac output and physical activity increased compared to baseline at day 7, 4, 22 and 42 respectively (p<0.05). Clinical worsening events led to deterioration in field walk test, WHO functional class and NT-proBNP (p<0.05). Remote monitored mean pulmonary artery pressure and total pulmonary resistance were increased and cardiac output and physical activity reduced 10 days prior to a clinical worsening event (p<0.05). ConclusionRemote haemodynamic and cardiac monitoring may provide a means for early, remote evaluation of clinical efficacy and early identification of clinical worsening in patients with pulmonary arterial hypertension.