Ambulatory Hemodynamic Monitoring of Pulmonary Hypertension

Elevated pulmonary artery pressure, typically called “pulmonary hypertension (PH)”, may occur owing to several pathophysiological conditions. The World Health Organization (WHO) proposed 5 classifications of PH, primarily based on causality, in order to guide research and provide a framework for therapeutic intervention. The WHO group II PH is most common and characterized by a mean pulmonary artery (PA) pressure higher than 25 mmHg that is associated with a pulmonary capillary wedge pressure greater than 15 mmHg. This hemodynamic profile suggests that PA pressure is elevated in cases of left ventricular (LV) failure, such as severe mitral valve disease (stenosis or regurgitation), LV diastolic failure, or LV systolic failure. Patients with elevated PA pressure experience abnormal dyspnea on exertion as well as severe symptoms such as dyspnea at rest. Further elevations in PA pressures can cause fluid to exudate fluid from the intravascular to the extravascular space, leading to pulmonary edema and severe, potentially life-threatening decompensation that require in-hospital care. Recently developed ambulatory implantable hemodynamic monitors help physicians remotely measure direct PA pressure from patients’ homes. Monitoring PA pressures allows healthcare specialists to monitor patient stability by evaluating the response to therapy adjustments, ultimately reducing hospitalization.