Devices, systems, and methods for pulmonary arterial hypertension (PAH) assessment and treatment
Provided herein are devices, systems, and methods for assessing, treating, and for developing new treatments for pulmonary arterial hypertension (PAH) using pulmonary artery pressure (PAP) values and/or cardiac output (CO) estimates.
1. A method of evaluating progress of pulmonary arterial hypertension (PAH) in a subject, or an outcome in the subject having PAH, comprising:
administering a pharmaceutical agent to the subject;
implanting a wireless pressure sensor in a pulmonary artery of the subject;
obtaining a pulmonary artery pressure waveform over a cardiac cycle from the wireless pressure sensor;
determining one or more pulmonary artery pressure (PAP) values experienced within the pulmonary artery from the pulmonary artery pressure waveform;
estimating cardiac output (CO) using one or more of the PAP values experienced within the pulmonary artery over the cardiac cycle;
comparing one or more of the PAP values and one or more of the CO estimates to standard PAP and CO values respectively, wherein the standard CO value is based on one or more previously estimated CO values from the subject;
using the comparisons of PAP and CO to monitor a PAH progression or outcome in the subject; and
changing at least one of the pharmaceutical agent, dosage or dosing regimen based on the comparison of the PAP and CO.
2. The method of claim 1 , wherein the standard PAP value is one or more previously determined PAP values from the subject.
3. The method of claim 1 , wherein:
a. a decrease in the one or more PAP values compared to the standard PAP value combined with one or more increased or stable CO estimates compared to the standard CO value, or
b. one or more stable PAP values compared to the standard PAP value combined with one or more increased CO estimates compared to the CO standard value indicates or predicts improvement of the PAH in the subject.
4. The method of claim 1 , wherein:
a. a decrease in one or more CO estimates compared to the standard CO value combined with one or more increased or stable PAP values compared to the standard PAP value, or
b. an increase in one or more PAP values compared to the standard PAP values combined with a stable or decreased CO value compared to the standard CO value indicates or predicts worsening of the PAH in the subject.
5. The method of claim 1 , wherein the pressure sensor lacks percutaneous connections.
6. The method of claim 5 , wherein the pressure sensor is energized from an external source.
7. The method of claim 6 , wherein the pressure sensor is a passive sensor energized to return pressure readings by an electromagnetic field.
8. The method of claim 1 , wherein the pulmonary artery pressure waveform is obtained while the subject is exercising.
9. The method of claim 1 , wherein the pulmonary artery pressure waveform is obtained while the subject is asleep.
10. The method of claim 1 , further comprising modifying or maintaining the administration of the pharmaceutical agent.
11. The method of claim 10 , further comprising maintaining administration of the pharmaceutical agent at its current dosage and or dosing regimen when improvement is indicated.
12. A method for evaluating treatment of a subject having pulmonary arterial hypertension (PAH), comprising:
administering an agent to the subject;
implanting a wireless pressure sensor in a pulmonary artery of the subject;
obtaining a pulmonary artery pressure waveform over a cardiac cycle from the wireless pressure sensor;
determining one or more pulmonary artery pressure (PAP) values experienced within the pulmonary artery from the pulmonary artery waveform;
estimating cardiac output (CO) using one or more of the PAP values experienced within the pulmonary artery over the cardiac cycle;
comparing one or more of the PAP values and one or more of the CO estimates to standard PAP and CO values respectively, wherein the standard CO value is based on one or more previously estimated CO values from the subject;
using the comparisons of PAP and CO to monitor an effect of the administered agent on the PAH condition in the subject; and
changing at least one of the pharmaceutical agent, dosage or dosing regimen based on the comparison of the PAP and CO.
13. The method of claim 12 , wherein the standard PAP value is based on one or more previously determined PAP values from the subject.
14. The method of claim 12 , wherein:
a. a decrease in the one or more PAP values compared to the standard PAP value combined with one or more increased or stable CO estimates compared to the standard CO value, or
b. one or more stable PAP values compared to the standard PAP value combined with one or more increased CO estimates compared to the CO standard value indicates or predicts improvement of the PAH in the subject.
15. The method of claim 12 , wherein:
a. a decrease in one or more CO estimates compared to the standard CO value combined with one or more increased or stable PAP values compared to the standard PAP value, or
b. an increase in one or more PAP values compared to the standard PAP values combined with a stable or decreased CO value compared to the standard CO value indicates or predicts worsening of the PAH in the subject.
16. The method of claim 12 , wherein the standard is a PAP of 25 mmHg.
17. The method of claim 16 , wherein the obtained reading is less than 25 mmHg.
18. The method of claim 17 , wherein one or more PAP values of the subject determined prior to determining the PAP value from the obtained pulmonary artery pressure waveform are greater than 25 mmHg.
19. The method of claim 12 , wherein the pressure sensor lacks percutaneous connections.
20. The method of claim 19 , wherein the pressure sensor is energized from an external source.
21. The method of claim 20 , wherein the pressure sensor is a passive sensor energized to return pressure readings by an electromagnetic field.
22. The method of claim 12 , wherein the pulmonary artery pressure waveform is obtained while the subject is exercising.
23. The method of claim 12 , wherein the pulmonary artery pressure waveform is obtained while the subject is asleep.
24. The method of claim 12 , wherein the monitored effect is used to determine an effective dosage for the agent.
25. The method of claim 12 , further comprising modifying or maintaining the administration of the pharmaceutical agent.
26. The method of claim 12 , further comprising maintaining administration of the pharmaceutical agent at its current dosage and or dosing regimen when improvement is indicated.