Paul R. Kalra MA, MB BChir, MD , Irakli Gogorishvili MD , George Khabeishvili MD , Filip Málek MD, PhD, MBA , Ondřej Toman PhD, MHA , Chris Critoph BM, MD , Andrew S. Flett MBBS, MD, CCDS , Peter J. Cowburn MD , Mandeep R. Mehra MD, MSc , William S. Sheridan PhD , John R. Britton PhD, MBA , Teresa Buxo MSc , Robyn M. Kealy MSc , Annette Kent PhD , Barry R. Greene PhD , Kaushik Guha MD , Roy S. Gardner MBChB, MD , Ian Loke MBChB, MD , Ali Vazir PhD, MBBS , Jasper J. Brugts MD, PhD, MSc , Kevin Damman MD, PhD
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引用次数: 0
Abstract
Background
Variations of inferior vena cava (IVC) area and collapsibility serve as early markers of congestion and predict risk for heart failure (HF) events.
Objectives
The aim of this first-in-human study (FUTURE-HF [First in Human Clinical Investigation of the FIRE1 System in Heart Failure Patients]) was to evaluate the safety and feasibility of a novel implantable IVC sensor for remote management in patients with HF. This paper is the final report on primary (3-month) and exploratory (6-month) endpoints.
Methods
Patients with HF hospitalizations within the previous year, with elevated natriuretic peptide levels, and on optimal HF treatment were included. The primary safety endpoints were procedural success without device- or procedure-related complications at 3 months. The primary technical endpoint was signal acquisition following implantation and at a clinic visit within 3 months. Sensor-derived IVC area was compared with computed tomography (CT)–based IVC dimensions. Patient adherence to daily readings and exploratory clinical findings at 6 months were assessed.
Results
Fifty patients underwent successful implantation (mean age 65 ± 9 years, 14% women, 72% in NYHA functional class III), with 49 contributing to the primary safety and technical endpoints at 3 months. Sensor-derived IVC area demonstrated excellent agreement with CT measurement (mean absolute error 13.53 mm2 [3.55%] R2 = 0.98). Median adherence was 96% at 6-month follow-up. Exploratory analyses of clinical outcomes suggested improvements in N-terminal pro–B-type natriuretic peptide, NYHA functional class, and quality of life and reduced HF events.
Conclusions
This first-in-human experience demonstrated that the implantation of an IVC sensor was safe and feasible. Sensor-derived IVC area demonstrated excellent correlation with CT-derived IVC area, and exploratory clinical outcomes suggest that this may serve as a novel tool for ambulatory management of congestion to facilitate remote care in HF. (First in Human Clinical Investigation of the FIRE1 System in Heart Failure Patients [FUTURE-HF]; NCT04203576).
期刊介绍:
JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.