CardioMEMS remote monitoring detected rising pulmonary artery pressures and facilitated diuretic titration, preventing recurrent pleural effusions in a patient with post-CABG heart failure.
Case Report (n=1)
Does CardioMEMS remote monitoring prevent recurrent pleural effusions in post-CABG heart failure patients?
CardioMEMS-guided diuresis successfully prevented recurrent pleural effusions and hospitalizations in a post-CABG patient with heart failure and subacute pericarditis.
Abstract Background Recurrent pleural and pericardial effusions complicate up to 20% of post-coronary artery bypass grafting (CABG) cases, often driven by subacute pericarditis and volume overload in heart failure (HF), leading to dyspnea, thoracentesis, and hospitalizations. These thoracic manifestations intersect pulmonology and cardiology, with limited strategies for prevention. The CardioMEMS HF System enables remote pulmonary artery (PA) pressure monitoring to preempt decompensation, but its role in effusion-prone post-surgical HF remains unexplored, with no prior case reports identified in comprehensive PubMed and Scopus searches. Case Presentation A 57-year-old male with hypertension, hyperlipidemia, type 2 diabetes (A1c 6.2-6.7%), and CAD status post 2010 STEMI presented with HFmrEF (EF 50-55%). After CABG (April 2024), he developed subacute pericarditis with effusions, requiring pericardiocentesis (350 mL) and bilateral thoracenteses (2.9 L total) during May-June 2024 admissions, complicated by acute kidney injury (creatinine 5.0 mg/dL) necessitating CRRT and new-onset atrial fibrillation. CardioMEMS, implanted pre-CABG, detected rising PA pressures (mean increase 5-10 mmHg) and 11-pound weight gain one month post-op, prompting ambulatory torsemide escalation (40 mg daily). This resolved dyspnea and abdominal fullness without further effusions or admissions. Cardiac MRI confirmed pericarditis resolution and EF recovery (40-45% to 56%). Vital signs stabilized (BP 138/64 mmHg, O2 sat 95%), with no orthopnea or respiratory distress on follow-up. Discussion This first-reported use of CardioMEMS in post-CABG pericarditis prevented recurrent pleural effusions—a common pulmonary complication (incidence 10-20%) risking thoracentesis-related morbidity (e.g., pneumothorax in 2-5%). By identifying subclinical volume overload early, it facilitated diuretic titration, averting thoracic interventions amid renal constraints. Pivotal trials (CHAMPION, GUIDE-HF, MONITOR-HF) show 29-57% HF hospitalization reductions, but lack effusion-specific data; real-world meta-analyses (N 5,000) confirm congestion control benefits. This approach underscores the potential to alleviate pulmonary complications in heart failure management, as maintaining euvolemia through guided diuresis may mitigate the risk of recurrent effusions and lessen the overall respiratory burden. Conclusion CardioMEMS offers a proactive, non-invasive tool to mitigate effusion-driven respiratory events in post-surgical HF, bridging cardio-thoracic care. Randomized trials in effusion-prone cohorts are warranted to validate this approach. This abstract is funded by: No funding required
Shah et al. (Fri,) conducted a case report in Post-CABG heart failure with recurrent pleural effusions (n=1). CardioMEMS remote pulmonary artery pressure monitoring was evaluated on Prevention of recurrent pleural effusions. CardioMEMS remote monitoring detected rising pulmonary artery pressures and facilitated diuretic titration, preventing recurrent pleural effusions in a patient with post-CABG heart failure.