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Dr Joy M Thomas, Chennai 06 January 2018

The hemodynamic parameters that we should look at include LA pressure, autonomic adaptation in the form of heart rate and vagal nerve activity, fluid accumulation by thoracic impedance and body weight increase.
These parameters can be measured with remote monitoring devices and acted upon to treat and delay or avoid the oncoming hospitalization.
These devices have been tested in clinical trials: COMPASS HF, TELE HF, TIMI HF, HOMEOSTASIS and CHAMPION.
In monitoring patients with LVADs, there is difficulty in assessing the parameters because of continuous flow devices compared to the natural pulsatile flow that has been seen all along in native hearts. Compromises have been made by assessing Doppler derived pressures whose accuracy is questionable and less than desirable.
Newer monitoring devices use integrated flow probes that by a feedback mechanism are able to control the output monitor data as well.
Newer challenges will be to create “smart pumps” that are able to integrate right ventricular pressures, filling and flow and to integrate them with left ventricular functions will be the monitoring device of the future with artificial intelligence thrown in.

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