However, during treatment, either biomarker predicts the risk of major adverse outcomes in patients treated with sacubitril/valsartan (8). 5.2.6. Filling Pressure Assessment When and How to Measure Filling Pressures Whereas routine pulmonary artery catheterization is not recommended to manage congestion, invasive hemody- namic and lling pressure assessment may occasionally be useful to support decision-making. For example, in patients who have refractory symptoms despite perceived adequate use of diuretic agents, those who develop worsening renal function with attempts to increase doses of diuretic agents, or those with repeated hospitalization for congestion, a better understanding of lling pressures and hemodynamics might assist in pivotal changes in HF therapies. Pulmonary artery catheterization results may also help select candidates for advanced therapies, including transplantation or mechanical circulatory support. Recent attention has focused on the use of implantable sensors to guide lling pressure assessment in ambula- tory patients with HF. In the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III HF Patients) study, patients with NYHA class III HF symptoms were randomly assigned to receive a wireless implantable pulmonary artery pressure monitor versus usual care (62). Patients who were managed with data from implantable pulmo- nary artery pressure monitoring experienced more changes in GDMT and diuretic doses (63). In addition, those managed with implantable pulmonary artery pres- sure monitoring had a 28% relative reduction in HF hos- pitalization (0.49 events/patient/year in the treatment arm versus 0.69 events/patient/year in the control arm; p < 0.001). Such improvement was seen in patients with both HFrEF and HF with preserved EF. This suggests that in well-selected patients with recurrent congestion, this highly specialized monitoring strategy may guide thera- peutic decision-making. 