Journal Article

PREDICT HF: Risk stratification in advanced heart failure using novel hemodynamic parameters

Cyrille‐Superville, Nicole, Snipelisky, David F., Najjar, Samer S., Patel, Priyesh A., Grinstein, Jonathan, Belkin, Mark, Rao, Sriram D., Feliberti, Jason P., Jeng, Eric I., Goswami, Rohan M., Sinha, Shashank S., Swayampakala, Kamala, Carroll, Aubrie M.

2024

Overview

Background Invasive hemodynamics are fundamental in assessing patients with advanced heart failure (HF). Several novel hemodynamic parameters have been studied; however, the relative prognostic potential remains ill‐defined. Hypothesis Advanced hemodynamic parameters provide additional prognostication beyond the standard hemodynamic assessment. Methods Patients from the PRognostic Evaluation During Invasive CaTheterization for Heart Failure (PREDICT‐HF) registry who underwent right heart catheterization (RHC) were included in the analysis. The primary endpoint was survival to orthotopic heart transplant (OHT) or durable left ventricular assist device (LVAD), or death within 6 months of RHC. Results Of 846 patients included, 176 (21%) met the primary endpoint. In a multivariate model that included traditional hemodynamic variables, pulmonary capillary wedge pressure (PCWP) (OR: 1.10, 1.04−1.15, p < .001), and cardiac index (CI) (OR: 0.86, 0.81−0.92, p < .001) were shown to be predictive of adverse outcomes. In a separate multivariate model that incorporated advanced hemodynamic parameters, cardiac power output (CPO) (OR: 0.76, 0.71−0.83, p < .001), aortic pulsatility index (API) (OR: 0.94, 0.91−0.96, p < .001), and pulmonary artery pulsatility index (OR: 1.02, 1.00−1.03, p .027) were all significantly associated with the primary outcome. Positively concordant API and CPO afforded the best freedom from the endpoint (94.7%), whilst negatively concordant API and CPO had the worst freedom from the endpoint (61.5%, p < .001). Those with discordant API and CPO had similar freedom from the endpoint. Conclusion The advanced hemodynamic parameters API and CPO are independently associated with death or the need for OHT or LVAD within 6 months. Further prospective studies are needed to validate these parameters and elucidate their role in patients with advanced HF. (A) Improved risk stratification of advanced heart failure using the advanced hemodynamic parameters, aortic pulsatility index (API), and cardiac power output (CPO). The simultaneous incorporation of API and CPO into risk models defines three patient populations ([1] concordantly high API and CPO [best prognosis], [2] discordant API and CPO [intermediate prognosis], [3] concordantly low API and CPO [worst prognosis]) with incremental risk of the combined end‐point of death, left ventricular assist device or transplant at 6 months. (B) API and CPO measurements depicted utilizing pressure−volume loops. C. Pressure−volume loops demonstrating the relationship and utility of API and CPO in different clinical states.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: Aged / Blood pressure / Cardiac arrhythmia / Cardiac Catheterization / Cardiovascular disease / Clinical / Creatinine / Demographics / Female / Heart attacks / Heart failure / Heart Failure - diagnosis / Heart Failure - mortality / Heart Failure - physiopathology / Heart Failure - therapy / Heart Transplantation / Heart-Assist Devices / Hemodynamics / Hemodynamics - physiology / Humans / Intubation / Laboratories / Male / Middle Aged / novel hemodynamics / Patients / Predictive Value of Tests / Prognosis / prognostication / Pulmonary arteries / Pulmonary Wedge Pressure - physiology / Registries / Regression analysis / Retrospective Studies / Risk Assessment - methods / Risk Factors / Statistical analysis / Time Factors / Transplants & implants / United States - epidemiology / Ventricular Function, Left - physiology