Background
Patients with advanced heart failure (HF) frequently experience recurrent decompensations despite receiving guideline-directed medical therapy (GDMT) and device-based treatment. Continuous pulmonary artery pressure (PAP) monitoring through telemetric systems in the outpatient setting enables early detection of elevated pressures, potentially supporting timely treatment, better overall management of HF patients and a possible reduction in HF hospitalizations.
Case Summary
We report the case of a 71-year-old woman with chronic heart failure with reduced ejection fraction (HFrEF, LVEF 15-25%), initially diagnosed in 2003 and progressing to advanced HF by 2019. The underlying cause was dilated cardiomyopathy following a prior myocardial infarction complicated by inferior aneurysm formation. Her medical history includes biological mitral valve replacement and tricuspid valve reconstruction in 2019, CRT-D implantation in 2019, persistent atrial fibrillation, recurrent ventricular tachycardias, and stage 3B chronic kidney disease. Since her first presentation to our HF clinic in 2024, she continued to experience progressive exertional dyspnea (NYHA class III), peripheral edema, reduced exercise capacity, and persistently elevated NT-proBNP levels despite optimized GDMT. After joint decision-making by the HF team and patient, a CardioMEMS HF system was implanted in June 2024 to enable daily remote PAP monitoring. In the subsequent months, continuous hemodynamic monitoring facilitated precise titration of loop diuretics, leading to a reduction in mean PAP by approximately 5-7 mmHg. The patient reported subjective improvements in dyspnea and exercise tolerance, and no further HF-related hospitalizations occurred during this period. NT-proBNP levels showed a modest decline, consistent with the improved hemodynamics. From January to August 2025, despite more stabilized volume status, she experienced intermittent episodes of ventricular tachycardia. Renal function remained chronically impaired, necessitating careful titration of diuretics and GDMT to avoid prerenal injury. Beginning in June 2025, telemetric monitoring revealed a gradual increase in mean PAP, which initially fluctuated but later remained persistently elevated at 35-40 mmHg. This trend preceded the patient’s clinical decline and served as an early indicator of impending decompensation. In October 2025, recurrent ventricular arrhythmias with hemodynamic instability and cardiac decompensation required a ventricular tachycardia ablation. The CardioMEMS sensor continued to provide reliable PAP readings, which guided both diuretic adjustments and clinical decision-making.
Conclusion
This case demonstrates the feasibility and effectiveness of PAP-guided therapy using the CardioMEMS HF system in a complex patient with advanced HF and chronic kidney disease. Continuous telemetric hemodynamic monitoring enabled individualized adjustments of therapy, supported better management of fluid status, and facilitated timely interventions. These findings underscore the potential of telemetric pulmonary artery pressure monitoring as a valuable adjunct to GDMT, offering real-time hemodynamic insights contributing to a proactive, personalized care in patients with advanced HF.
