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Noninvasive Hemodynamic Monitoring for Heart Failure: A New Era of Heart Failure Management

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      Abstract

      Despite the development of noninvasive tools as echocardiography, right-sided heart catheterization remains an integral part of the cardiovascular evaluation. In the last decade, better understanding of the hemodynamic process before heart failure decompensation led to improvement of outpatient strategies to prevent it. Advances in implantable wireless technology now allow frequent and direct measurement of intracardiac filling pressures, which can be monitored by health care providers to help tailor therapy to reduce filling pressures and hospital readmission rates.

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      Most cited references 46

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      Pathophysiology of the transition from chronic compensated and acute decompensated heart failure: new insights from continuous monitoring devices.

      Studies of cardiovascular signals continuously sensed by implantable devices provide unique insight into detailed pathophysiology as patients progress from stable to congested states. These data suggest that volume expansion, autonomic adaptation, and pulmonary interstitial edema begin several weeks before patients develop symptoms or demonstrate changes in daily weight. Monitoring physiologic signals from implanted devices may provide earlier warning of impending decompensation, thereby allowing changes in medical therapy to prevent worsening heart failure.
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        Beyond the wedge: clinical physiology and the Swan-Ganz catheter.

         S Sharkey (1987)
        The Swan-Ganz catheter was introduced into general clinical medicine in 1970 and quickly gained widespread use in the management of critically ill patients. The device offers highly sophisticated physiologic information; however, in many instances, only the wedge pressure and the cardiac output are utilized when managing acutely ill patients. The purpose of this review is to illustrate and explain the array of physiologic data available from the Swan-Ganz catheter in most circumstances. A basic understanding of the information that can be obtained with the Swan-Ganz catheter is quite useful in the diagnosis and management of a variety of cardiovascular disorders. In addition, the Swan-Ganz catheter can be a helpful tool for teaching cardiovascular pathophysiology.
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          Disease management: remote monitoring in heart failure patients with implantable defibrillators, resynchronization devices, and haemodynamic monitors.

          Heart failure represents a major public health concern, associated with high rates of morbidity and mortality. A particular focus of contemporary heart failure management is reduction of hospital admission and readmission rates. While optimal medical therapy favourably impacts the natural history of the disease, devices such as cardiac resynchronization therapy devices and implantable cardioverter defibrillators have added incremental value in improving heart failure outcomes. These devices also enable remote patient monitoring via device-based diagnostics. Device-based measurement of physiological parameters, such as intrathoracic impedance and heart rate variability, provide a means to assess risk of worsening heart failure and the possibility of future hospitalization. Beyond this capability, implantable haemodynamic monitors have the potential to direct day-to-day management of heart failure patients to significantly reduce hospitalization rates. The use of a pulmonary artery pressure measurement system has been shown to significantly reduce the risk of heart failure hospitalization in a large randomized controlled study, the CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients (CHAMPION) trial. Observations from a pilot study also support the potential use of a left atrial pressure monitoring system and physician-directed patient self-management paradigm; these observations are under further investigation in the ongoing LAPTOP-HF trial. All these devices depend upon high-intensity remote monitoring for successful detection of parameter deviations and for directing and following therapy.
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            Author and article information

            Affiliations
            1Division of Cardiology, Department of Medicine, University of Miami, Miami, FL, USA
            2Cleveland Clinic Florida, Weston, FL, USA
            Author notes
            Correspondence: Sandra Chaparro, MD, Division of Cardiology, Department of Medicine, University of Miami, Clinical Research Building, Room 1110, 1120 NW 14th Street, Miami, FL 33136, USA, Tel.: +(305) 243-5138, Fax: +(305) 243-5578, E-mail: schaparro1@123456med.miami.edu
            Journal
            CVIA
            Cardiovascular Innovations and Applications
            CVIA
            Compuscript (Ireland)
            2009-8618
            2009-8618
            October 2015
            October 2015
            : 1
            : 1
            : 57-64
            Copyright © 2015 Cardiovascular Innovations and Applications

            This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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