Heart failure hemodynamic monitoring

Invasive hemodynamic monitoring should be considered in patients who are refractory to initial therapy, whose volume status is unclear, or who have clinically significant hypotension such as systolic BP <80 mm Hg. Such monitoring helps guide treatment and classify patients into four specific hemodynamic subsets based on cardiac index and pulmonary artery occlusion pressure (PAOP). Refer to textbook Chap. 16 (Heart Failure) for more information. 

There are two general approaches to maximize therapy in the ad-vanced/decompensated heart failure patient. One is to use simple clinical parameters (i.e., signs and symptoms, blood pressure, and renal function), and the other is to use invasive hemodynamic monitoring. However, it is frequently necessary to combine the two approaches. 

Integration of sensors for monitoring a broader range of patients clinical status in areas such as cardiac hemodynamics and ischemia status. (At least one manufacturer already provides a feature that uses monitoring of transthoracic impedance as a way to assess pulmonary congestion in heart failure patients with a CRT device)... 

Bourge RC, Abraham WT, Adamson PB, Aaron MF, Aranda JM, Jr., Magalski A et al. Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure The COMPASS-HF study. Journal of the American College of Cardiology. 2008 51(11) 1073-1079. 

Thoracic fluid is associated with decreased impedance between a ventricular lead and the pacing system generator. Two preliminary clinical studies have reported varying results on the clinical utility of thoracic impedance monitoring for predicting hemodynamic status. The Medtronic Impedance Diagnostics in Heart Failure Trial (MlD-HeFT) evaluated 33 patients with Class III or IV heart failure due to systolic dysfunction (n = 25) or diastolic dysfunction (n =... 

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