Elsevier

The American Journal of Cardiology

Volume 183, 15 November 2022, Pages 55-61
The American Journal of Cardiology

Comparative Prognostic Value of Parameters of Pulsatile Right Ventricular Afterload in Patients With Advanced Heart Failure Awaiting Heart Transplantation

https://doi.org/10.1016/j.amjcard.2022.08.010Get rights and content

Right ventricular pulsatile afterload (RVPA) demonstrated a strong impact on survival of patients with advanced heart failure (HF) with reduced ejection fraction. The best prognostic parameter of RVPA is unknown. The aim of this work was to examine the prognostic relevance of pulmonary artery compliance (PAC), pulmonary artery elastance (PAE), and pulmonary artery pulsatile index (PAPi) in a consecutive cohort of patients with advanced HF evaluated for heart transplantation (HT).

A total of 149 patients with end-stage HF underwent right-sided cardiac catheterization and were clinically followed up until death or any censoring events, including HT, left ventricular assist device, and hospitalization for acute HF. The primary endpoint occurred in 29 patients (19.5%) during a median follow-up time of 12 (interquartile range 3 to 34) months. This cohort presented a worse hemodynamic profile than event-free survivors. PAC <1.9 mL/mm Hg (hazard ratio 3, 95% confidence interval 1.3 to 6.0, p= 0.007) and PAE >0.9 mmHg/mL (hazard ratio 2.5, 95% confidence interval 1.1 to 5.2, p= 0.02) were associated with the adverse outcome. On the contrary, PAPi was not associated with the outcome. PAC demonstrated a superior predictive value for the composite adverse outcome compared with pulmonary vascular resistance (area under the curve comparison p= 0.019) and PAPi (p= 0.03) but similar compared with PAE (p= 0.19) and mean pulmonary arterial pressure (p= 0.51). PAC, but not PAE, showed incremental prognostic value compared with cardiac index (p= 0.02). In conclusion, hemodynamic indexes of RVPA are associated with worse survival in patients with end-stage HF. PAC and PAE demonstrated superior prognostic value compared with PAPi and pulmonary vascular resistance. Moreover, PAC showed incremental prognostic value compared with cardiac index in patients awaiting HT.

Section snippets

Methods

This was an observational and retrospective analysis including patients who underwent right-sided cardiac catheterization at Verona University Hospital, during the evaluation for HT between April 2007 and May 2021. The cohort of patients were followed up from the day of right-sided cardiac catheterization until death or any censoring events, including HT, LV assist device (LVAD) implantation, or new hospitalizations for acute heart failure. The inclusion criteria were patients aged older than

Results

Between April 2007 and May 2021, a total of 181 patients with advanced heart failure and left ventricle dysfunction were enlisted for HT at the Department of Cardio-thoracic Surgery of Verona. Complete dataset, including right-sided cardiac catheterization, echocardiographic data, and clinical follow-up, were available for 149 patients who were include this analysis (Figure 1).

The baseline characteristics of study cohort are shown in Table 1. The mean age was 56.6 ± 10.1 years and 85% were men.

Discussion

The main results of our analysis are as follows: (1) determinants of pulsatile RV afterload are strongly associated with adverse outcome in patients with end-stage HFrEF awaiting HT. (2) In particular, PAC but not mPAP demonstrated to be independently associated with the composite end point. (3) PAC provided superior prognostic performance compared with conventional parameters, including cardiac index and PVR.

RV function is an important prognostic determinant in patients with advanced HFrEF.16

Disclosures

The authors have no conflicts of interest to declare.

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