Methods: We retrospectively analyzed data from the CHAMPION trial of a wireless IHM in 550 NYHA class III HF patients, regardless of HF etiol- ogy or LVEF.
S92
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2014
RRT (18%) and those who did not (82%). Patients requiring RRT had a tendency towards more post-operative infections (40% vs. 12%, p= 0.06). Conclusion: The need for RRT post-transplant was the only characteristic identified that predicts a poor prognosis in HF patients with AL amyloidosis undergoing HT/ASCT.
2( 37) Limitations of Right Heart Catheterization in the Diagnosis and Risk Stratification of Patients with Pulmonary Hypertension: Insights from the CHAMPION Trial A. Raina ,1 R.C. Bourge,2 W. Abraham,3 P. Adamson,4 J. Bauman,5 J. Yadav,5 R.L. Benza.1 1Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA; 2Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL; 3Division of Cardiology, Ohio State University, Columbus, OH; 4Heart Failure Institute, Oklahoma Heart Hospital, Oklahoma City, OK; 5Cardiomems, Inc, Atlanta, GA. Purpose: For WHO Group I and II pulmonary hypertension (PH) patients, assessment of pulmonary hemodynamics during a right heart catheterization (RHC) is required to confirm the diagnosis of PH and to evaluate disease progression and treatment efficacy. However, invasive RHC is frequently performed under artificial conditions and may not reflect the true extent of hemodynamic compromise. Assessment using an implantable hemodynamic monitoring (IHM) device that measures pulmonary artery pressure (PAP) at multiple time points may provide an improvement over current methods. We report data from the CHAMPION trial that highlight the limitations of RHC and the potential benefits of a IHM device for PH diagnosis and risk stratification. Methods: The CHAMPION trial enrolled 550 patients with NYHA class III HF who were implanted with the IHM device and took daily PAP readings from home. The IHM device is implanted in the PA and calibrated using RHC data. Mean PAP (mPAP) data from the RHC was compared to the 1st week of IHM mPAP data. Annualized heart failure hospitalization (HFH) rates were used as the metric for patient risk. Results: RHC identified 320 patients with PH (mPAP> 25 mmHg). RHC mPAP was similar to the average 1st week IHM mPAP (35.8 vs. 36.2mmHg, p= 0.5066). These patients had a HFH rate of 0.76/yr. RHC identified 217 patients without PH (mPAP≤ 25 mmHg). RHC mPAP was 4.9 mmHg lower than the average 1st week IHM mPAP (19.8 vs. 24.7 mmHg, p 25 mmHg. RHC mPAP was 10.0 mmHg lower than the average 1st week IHM mPAP (21.2 vs. 31.2 mmHg, p 25 mmHg had significantly higher HFH rates than the 111 with average 1st week IHM mPAP≤ 25mmHg (0.49 vs. 0.25/yr, p= 0.0007). Conclusion: Using only RHC, WHO Group II PH may be significantly underdiagnosed. In patients with RHC mPAP≤ 25 mmHg, more frequent PAP monitoring using an IHM device can provide better data for diagnosis and risk stratification than a single RHC alone.
2( 38) Use of a Wireless Implantable Hemodynamic Monitor Leads to Reductions in Heart Failure Hospitalizations Among WHO Group II Pulmonary Hypertension Patients A. Raina ,1 R.C. Bourge,2 W. Abraham,3 P.B. Adamson,4 J. Bauman,5 J. Yadav,5 R.L. Benza.1 1Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA; 2Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL; 3Division of Cardiology, Ohio State University, Columbus, OH; 4The Heart Failure Institute, Oklahoma Heart Hospital, Oklahoma City, OK; 5Cardiomems, Inc, Atlanta, GA. Purpose: Morbidity and mortality in heart failure (HF) remain high despite contemporary therapy, especially in patients with concomitant pulmonary hypertension (PH). RHC is used to risk stratify patients with HF and to determine the etiology and severity of PH. However, implantable hemodynamic monitors (IHM) can provide ongoing hemodynamic data which affords the opportunity for optimal medical management of HF patients with PH. Methods: We retrospectively analyzed data from the CHAMPION trial of a wireless IHM in 550 NYHA class III HF patients, regardless of HF etiology or LVEF. Comparison was made between a WHO Group II PH cohort (defined as mPAP> 25mmHg) and non-PH cohort (mPAP 15 mmHg (RRR 30%) and PVR> 3 WU (RRR 33%). Among PH patients, there was a non-significant trend towards improved survival with knowledge of IHM parameters (HR 0.78, 95% CI 0.50-1.22). Conclusion: Ongoing knowledge of data from an IHM can lead to substantial reductions in hospitalizations across a broad cohort of WHO Group II PH patients. 2( 39) Demographics and Outcomes from a Binational Australian and New Zealand Registry for Adults with Congenital Heart Disease and Pulmonary Arterial Hypertension M.L. Rose ,1 G. Strange,2 L. Grigg,3 F. Kermeen,4 C. O’Donnell,5 I. King,1 D. Celermajer,6 R. Weintraub.1 1The Murdoch Children’s Research Institute, Parkville, Australia; 2Notre Dame University, Perth, Australia; 3Royal Melbourne Hospital, Parkville, Australia; 4Queensland Service, Brisbane, Australia; 5The Starship Children’s Hospital, Auckland, Australia; 6The Royal Prince Alfred Hospital, Sydney, Australia. Purpose: Improving care of congenital heart disease patients has resulted in a new population of adult congenital heart disease (ACHD) survivors who are at risk of complications including heart failure, arrhythmias and pulmonary arterial hypertension (PAH). This study was undertaken to better understand management patterns and long-term outcomes of these patients. Methods: A binational ANZ web-based registry for adult CHD patients with associated PAH was established. The inclusion criteria were patients aged > 16 yrs, seen at least once in an adult CHD centre after 1/1/2000, with a confirmed diagnosis of PAH. Results: Of the 360 adults enrolled, 66% were classified as having simple lesions (ASD, VSD and PDA) and 68% had Eisenmenger Syndrome (ES). At the time of first ACHD visit, 56% of cases were Functional Class (FC) III
