Researchers at UVA Health developed a new heart function measurement that could significantly reduce deaths and hospitalizations from systolic heart failure and pulmonary hypertension. Currently, half of patients with these conditions die within 5 years of diagnosis, but better identification could help many of them survive.
The study is the first to show a survival benefit from wireless pressure monitoring sensors implanted in the pulmonary arteries. Constantly monitoring pulmonary artery proportional pulse pressure (PAPP) provides a new way to learn which patients are at high risk for these two conditions.
“It can identify patients that are at greatest risk of dying or being hospitalized,” said Sula Mazimba, MD, MPH, a heart failure expert at UVA Health. “This allows us to tailor more aggressive treatments.”
Identifying the Measure
Previous research showed that patients with low PAPPs were at far greater risk than those with higher PAPPs, so UVA researchers tested whether these benefits were maintained in patients undergoing implantation of pressure sensors that continuously monitor pressure in the pulmonary artery.
“We found that PAPP is a very good measure of how stiff or compliant the pulmonary arteries are,” said Mazimba. “The stiffness of the pulmonary arteries determines how much resistance the right side of the heart has overcome to pump blood effectively to the lungs.”
In the study, for patients with low PAPPs, monitoring reduced the risk of death by 46% annually during 2 to 3 years of follow-up.
Researchers recently published the findings in Heart, Lung and Circulation.
UVA’s new study evaluated the benefits of PAPP monitoring in patients with systolic heart failure, in which the heart’s left ventricle is weak, as well as those with pulmonary hypertension.
To test whether PAPP monitoring could predict outcomes in these patients, Mazimba and his colleagues reviewed data from 550 participants in the CHAMPION clinical trial. In the trial, participants were randomized to receive an implantable, wireless heart monitor called the CardioMEMS HF System.
Mazimba and his collaborators found that participants with a below-average PAPP had a significantly higher risk of hospitalization or death than those with higher PAPPs.
Maximizing Technology, Increasing Survival
“The implications of this study are highly significant,” said Kenneth Bilchick, MD, MS, a cardiologist at UVA Health and co-investigator on the study. “We now have identified a specific group of patients who appear to have a marked improvement in survival with implantation of these pulmonary artery wireless monitors. As a result, the findings of the study could maximize the impact of this technology for a large number of patients. This is an excellent example of how secondary analyses of clinical databases maintained by the National Institutes of Health can result in novel and personalized approaches to patient care.”
The UVA researchers say more study is needed to determine the full potential of PAPP monitoring to improve care for patients with heart failure, but they were encouraged by the early results.
“In the past, the function of the right chamber of the heart was often ignored and considered to be inconsequential to the overall performance of the heart, but we are now learning that this is not the case,” Mazimba said. “Having tools that signal when the right side of the heart is under strain may aid clinicians to adopt timely, tailored treatments for patients with heart failure.”