Tolerability and Safety of CARDIOMEMS™ Intracardiac Continuous Cardiac Hemodynamic Monitoring Device in Patients With Cardio Renal Syndrome With Severe Renal Impairment (CARDIOMEMS)

Description

There are currently 1.5 million heart failure patients in France. The high morbidity and mortality make it a major public health issue. Renal failure, present in 40% of these patients, is one of the main comorbidities of heart failure and makes its management more complex. Medical follow-up with pulmonary artery pressure (PAP) monitoring has shown a reduction in mortality and frequency of hospitalization in patients with heart failure alone in the CHAMPION trial. Patients with New York Heart Association class III heart failure and a hospitalization in the previous 12 months were included in this study. They benefited from the "CardioMEMS™ HF" device with implantation of a sensor in the pulmonary artery allowing direct and continuous measurement of PAP. According to this study, this information allowed for more precise and early adaptation of therapy by avoiding the occurrence of heart failure symptoms and reducing the frequency of hospitalizations. In this study, patients with impaired renal function were excluded (Glomerular Filtration Rate <25 mL/min/1.73m2), limiting the indication for treatment in these patients, and the evolution of renal function during the study was not reported.

Patients with heart failure associated with advanced renal failure are defined as having a cardio-renal syndrome, with a strong interaction between these 2 organs that may, in particular in the case of predominant right heart failure, require treatment by renal replacement or dialysis. According to the data available to date, the predominant hypothesis is a link between high venous pressure, renal repercussions and the need for dialysis. Additional follow-up data in this clinical situation are needed to confirm this link and to suggest the interest of continuous monitoring of PAP to improve the management of these patients with cardio-renal syndrome with severe renal impairment defined by a Glomerular Filtration Rate< 30 ml/min/1.73m2 (KDIGO Cardio-renal 2019). Therefore, the investigators wish to initiate a pilot study evaluating the tolerability of the "CARDIOMEMS™ HF" device in patients with cardio renal syndrome and obtain the first information on the relationship between cardiac hemodynamics and renal function in this population.

This is the first pilot study on the safety and tolerability of the use of the CardioMEMS™ HF medical device in cardio renal syndrome with severe renal impairment (documented by Glomerular Filtration Rate < 30 mL/min/1.73m2 measured by Iohexol clearance) treated medically and without renal replacement therapy.

In this study, the CARDIOMEMS™ HF device, the most successful implanted pulmonary arterial pressure monitoring system currently available on the market will be implemented. Its teletransmitted information can guide the treatment of patients with heart failure.This system, by responding to the recent international recommendations which advocate a better understanding of the hemodynamic situation in this pathology with in particular the link between pulmonary arterial pressure and renal function, could help us to identify innovative evaluation tools with a view to improving therapeutic management with the new treatments available in heart failure (AA House et al: HF in kidney disease: a KDIGO conference report).

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