The Utility of CardioMEMS Implantable Hemodynamic Monitoring Device in Heartware HVAD Patient with Recurrent Gastrointestinal Bleeding

Abstract

Introduction CardioMEMS heart sensor is a wireless implantable hemodynamic monitoring system that can guide the management of heart failure (HF). Its role in HF patients with left-ventricular assist device (LVAD) is undetermined. Gastrointestinal (GI) bleeding is a common complication in the LVAD population. Severe GI bleeding can lead to a hypovolemic state which results in decreased pulmonary artery pressure (PAP). In this case, we report the changes in PAP recorded by CardioMEMS in an LVAD patient with recurrent GI bleeding. Case Report A 66 year-old man with Heartware HVAD implantation for ischemic cardiomyopathy, atrial fibrillation, diabetes and CardioMEMS device implantation presented to the emergency department (ED) on 6/8 due to black stools for 4 days. He was hospitalized 3 times in the preceding 2 months for GI bleeding of unclear etiology requiring blood transfusions and monthly octreotide. In the ED, he was stable and LVAD interrogation did not show any events. However, he had a drop in hemoglobin (Hb) from a baseline of 8.9 g/dL to 6.9 g/dL. He underwent push enteroscopy during this hospital stay which demonstrated bleeding jejunal angioplastic lesions. The PAP readings during the episodes of GI bleeding were reviewed. There was a significant reduction in PAP at the date of symptom onset from one day prior; from 57/26 mmHg (mPAP 38 mmHg) on 6/3 to 48/24 mmHg (mPAP 34 mmHg) on 6/4 corresponding with 2 g/dL drop in Hb level (See figure). This phenomenon was seen in a prior episode of GI bleeding 2 months prior. The PAP numbers dropped considerably to 39/18 mmHg (mPAP 27 mmHg) at the onset of symptoms compared with 49/22 mmHg (mPAP 33 mmHg) 1 day prior associated with 2.9 g/dL decline in Hb level. During the time PAP changes were observed, diuretic therapy was not modified. Summary In patients implanted with CardioMEMS device, a sudden drop in PAP can herald a GI bleeding episode. Monitoring PAP trends can be helpful in LVAD patients who are at higher risk for GI bleeding.