Monitor Implant Aids in Evaluating PAH Patients on Therapy, Including Iron Supplements

A case report of a pulmonary arterial hypertension (PAH) patient who used an implanted hemodynamic monitor illustrates that improvements in pulmonary hemodynamics and right ventricle afterload with a “simple therapy” like oral iron supplements are both possible and measurable.

The study, “Hemodynamic response to treatment of iron deficiency anemia in pulmonary arterial hypertension: longitudinal insights from an implantable hemodynamic monitor,” was published in the journal Pulmonary Circulation.

Patients with PAH frequently have iron deficiency, a condition associated with worsening symptoms and increased mortality. Iron supplements are, for this reason, an attractive therapeutic strategy in a progressive disease with relatively few treatment options. However, how well PAH patients respond to iron therapy requires further study.

Researchers described the response of a patient with scleroderma-related PAH, who developed iron-deficiency anemia and was given oral supplements. The patient was a 59-year-old woman using an implantable hemodynamic monitor. This type of device is a wireless sensor placed in a distal branch of the pulmonary artery, that monitors daily pulmonary artery (PA) pressures, heart rate, and cardiac output. Researchers also calculated the woman’s right ventricular (RV) performance and RV afterload, such as total pulmonary resistance (TPR) and pulmonary arterial capacitance.

At the time the hemodynamic monitor was implanted, the woman had functional class III symptoms and was receiving triple-drug therapy (intravenous treprostinil, macitentan, and sildenafil) and showed normal hemoglobin levels. Within four months of monitoring and optimized prostacyclin therapy, she showed symptom improvements, but she later regressed despite stable drug therapy. A re-evaluation confirmed she had iron-deficiency anemia.

The patient began a therapy regimen of oral iron supplements, which normalized her hemoglobin levels and improved her iron profile. These changes were accompanied by a gradual and sustained reduction in pulmonary pressures, RV performance, and a favorable reduction in right ventricular afterload.

“This case illustrates the optimization of pulmonary hemodynamics and RV function in tandem with clinical improvement achieved by simple therapy of oral iron supplementation, using novel longitudinal hemodynamic assessment with an IHM [implantable hemodynamic monitor],” the team concluded. “The use of IHM in a select group of patients with PAH offers the ability to longitudinally follow the hemodynamic effects of therapies. This may also yield useful mechanistic insights.”