Key result
Stroke volume reserve index <=128% predicts ~527% higher 1-year risk of major events in systolic HF.
Why the study?
Current predictors of clinical deterioration in patients with HFrEF have limited accuracy.
Does stroke volume reserve index (SVRI) predict 1-year mortality and need for advanced therapies in ambulatory HFrEF patients?
Cohort (n=104)
No
Does stroke volume reserve index (SVRI) predict 1-year mortality and need for advanced therapies in ambulatory HFrEF patients?
Effect estimate: HR 6.27 (95% CI 2.19-17.94)
Absolute Event Rate: 44% vs 85%
p-value: p=<0.001
SVRI ≤128% is a strong, non-invasive predictor of 1-year mortality or need for advanced therapies in ambulatory HFrEF patients, potentially outperforming traditional CPET and invasive hemodynamic markers.
Background Current predictors of clinical deterioration in patients with heart-failure with reduced ejection fraction (HFrEF) have limited accuracy. We investigated whether stroke volume reserve index (SVRI) would predict 1-year mortality and need for advanced therapies in HFrEF patients. Methods We retrospectively studied a consecutive series of 104 ambulatory HFrEF patients (59±11 years, 89% men) at our center who underwent cardiopulmonary exercise testing (CPET) from January 2017 to September 2018. The primary outcome was defined as heart-transplantation, urgent left ventricular assist device (LVAD) implantation or death within 1 year of evaluation. SVRI was estimated at rest and at anaerobic threshold (AT) by VO 2 (oxygen consumption)/pulse and previously validated estimates of C[a-v]O 2 (arteriovenous difference in oxygen content). Multivariate regression selected the optimal predictors from clinical, CPET and right heart catheterization data. Results Among HFrEF patients studied, 39 (37.5%) deteriorated: 16 required heart-transplantation, 8 required LVADs and 15 died. SVRI 128% or less was the best predictor (OR 6.69, p=0.001), followed by an invasively determined resting cardiac index 2 L/min/m 2 or less (OR 3.18, p=0.02), and peak VO 2 below the International Society for Heart and Lung Transplantation (ISHLT) cut-off (OR 4.15, p=0.01). A scoring system derived from the SVRI (less than 128%: 2 points), peak VO 2 (below the ISHLT cut-off: 1 point), and cardiac index (less than 2 L/min/m 2 : 1 point) predicted clinical deterioration with a sensitivity of 64% and specificity of 81%. Conclusions SVRI is a non-invasive measurement that may predict deterioration in HFrEF patients more accurately than currently recommended predictors.
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Selevany et al. (2019) conducted a cohort in Systolic Heart Failure (HFrEF) (n=104). Stroke Volume Reserve Index (SVRI) ≤ 128% vs. SVRI > 128% was evaluated on 1-year event-free survival (free from death, urgent LVAD implantation, or heart-transplantation) (HR 6.27, 95% CI 2.19-17.94, p=<0.001). A stroke volume reserve index of 128% or less independently predicted a composite of death, urgent LVAD implantation, or heart transplantation at 1 year in patients with systolic heart failure (HR 6.27).
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