Higher mean carotid energy predicted all-cause mortality (HR 1.41; 95% CI 1.17-1.70), and higher aortic mean energy predicted heart failure hospitalization (HR 1.45; 95% CI 1.16-1.81) in AHF.
Cohort (n=166)
No
Do pre-discharge energetic hemodynamic parameters predict all-cause mortality and heart failure re-hospitalization in patients recovering from acute heart failure?
Pre-discharge energetic hemodynamic parameters, specifically mean carotid and aortic energy, independently predict mortality and re-hospitalization in acute heart failure patients, outperforming conventional pulsatile measures.
Hazard Ratio: 1.41 (95% CI 1.17–1.7)
Abstract Background Pulsatile hemodynamics reflects vascular function and is linked to cardiovascular outcomes. However, the prognostic significance of energetic hemodynamic parameters in patients recovering from acute heart failure (AHF) remains unclear. Purpose This study investigates the association between pre-discharge energetic hemodynamics and the risk of all-cause mortality and heart failure hospitalization. Methods We conducted a prospective cohort study enrolling patients hospitalized for acute heart failure (AHF) at a tertiary medical center between 2014 and 2024. After stabilization and prior to discharge, we assessed pulsatile and energetic hemodynamic parameters, including central pulse pressure (PP), carotid-femoral pulse wave velocity (cf-PWV), carotid augmentation index (AI), aortic mean energy (Ēao) and pulsatile energy (Epao), as well as carotid mean energy (Ēcar) and pulsatile energy (Epcar). The primary outcomes were all-cause mortality and heart failure re-hospitalization (HHF), with follow-up extending up to five years. The optimal thresholds of energetic hemodynamic parameters for predicting outcomes were determined using the Youden index. Results A total of 166 patients (age 60.8 ± 18.1 years, 73.5% men) with AHF were enrolled. Over a median follow-up of 23 months (interquartile range: 3-42.3 months), 48 (28.9%) patients died, and 82 (49.4%) experienced HHF events. Kaplan-Meier analysis showed that a higher Ēcar was associated with an increased risk of all-cause mortality, while a higher Ēao correlated with a greater risk of HHF (Figure). In multivariable Cox regression analysis, Ēcar independently predicted all-cause mortality (hazard ratio per 1 standard deviation, 95% confidence interval: 1.41, 1.17–1.70), whereas Ēao was significantly associated with a higher risk of HHF (1.45, 1.16–1.81), after adjusting for age, sex, hypertension, diabetes, renal function, and left ventricular ejection fraction (Table). In contrast, conventional pulsatile hemodynamic parameters, including central PP, cf-PWV, and carotid AI, were not associated with all-cause mortality or HHF risk. Conclusion Our study demonstrates that energetic hemodynamic parameters, particularly mean carotid and aortic energy, independently predict clinical outcomes in patients with AHF and outperform conventional pulsatile hemodynamic measures. Energetic hemodynamics offers a valuable framework for exploring the interaction between vascular function and ventricular performance in AHF patients.Figure.Kaplan-Meier curves Table.Multivariable Cox analyses
Chang et al. (Sat,) conducted a cohort in acute heart failure (AHF) (n=166). energetic hemodynamic parameters (mean carotid and aortic energy) vs. lower energetic hemodynamic parameters was evaluated on all-cause mortality and heart failure re-hospitalization (HHF) (HR 1.41, 95% CI 1.17-1.70). Higher mean carotid energy predicted all-cause mortality (HR 1.41; 95% CI 1.17-1.70), and higher aortic mean energy predicted heart failure hospitalization (HR 1.45; 95% CI 1.16-1.81) in AHF.