Abstract 2953: Non-invasive Hemodynamic Assessment by Vericor® Reveals Heart Failure Management by Clinical Assessment Alone Is Suboptimal in Ambulatory Patients and Leads to Increased Heart Failure Hospitalizations
Background: Unreliability of clinical assessment for the detection of rising left ventricular end-diastolic pressure (LVEDP)s has been previously shown by invasive techniques in patients with advanced heart failure (HF). The present study is the first to assess the adequacy of clinical assessment in ambulatory patients with mild to moderate HF using a previously validated and FDA-cleared noninvasive technology called Vericor® that utilizes arterial pressure changes during expiratory phase of valsalva maneuver, to measure LVEDP.
Methods: Clinical assessment comprising Jugular Venous Distension(JVD), rales, pedal edema and VeriCor-measured LVEDP were documented in 77 stable ambulatory patients with mild to moderate HF who presented to our HF clinic and were followed for 12 months.
Results: Patients with an LVEDP ≤ 20 mm Hg were considered adequately managed (Group I), while those with LVEDPs ≤ 20 mmHg were considered sub-optimally treated (Group II ). Physical signs were insensitive (JVD present in 28%, rales in 28% and pedal edema in 45%) in group II ( mean LVEDP 25.7 ± 3.6) mmHg. The distributions of age, race, etiology of HF, left ventricular ejection fraction and HF regimens were not significantly different in the two groups.
A significant majority (61%) of ambulatory patients considered optimally managed by clinical criteria, had an LVEDP of > 20 mmHg that was associated with an increased risk of hospitalizations (18-times higher than in patients with LVEDPs ≤ 20mmHg) and death.
By accurately identifying LVEDP levels and guiding HF treatment, non-invasive hemodynamic monitoring using the VeriCor technology may reduce hospitalizations and related costs.