Key result
New hemodynamic and biomarker risk score outperforms SHFM and MAGGIC in predicting 12-month major events.
Why the study?
The prognostic value of invasive hemodynamic parameters measured by right heart catheterization compared to established risk scores in patients with heart failure was unknown.
Does a new risk score incorporating invasive hemodynamics improve prediction of mortality, heart transplantation, or LVAD implantation in patients with HFrEF compared to established risk scores?
Cohort (n=883)
No
Does a new risk score incorporating invasive hemodynamics improve prediction of mortality, heart transplantation, or LVAD implantation in patients with HFrEF compared to established risk scores?
Effect estimate: AUC 0.78 at 12 months
p-value: p=<0.001
Incorporating invasive hemodynamic parameters alongside cardiac biomarkers and clinical variables significantly improves risk stratification in HFrEF patients compared to established models like SHFM and MAGGIC.
Aims Risk stratification in patients with heart failure patients is crucial. The prognostic value of invasive hemodynamic parameters measured by right heart catheterization compared to established risk scores remains unknown. Methods and results This retrospective analysis included 883 patients. The combined endpoint was all-cause mortality, heart transplantation or left ventricular assist device implantation. A Cox proportional hazards model assessed the impact of invasive parameters, cardiac biomarkers, and patient characteristics, comparing them with the Seattle Heart Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) Score. A new score was created including mean pulmonary arterial (PA) pressure, mean right atrial pressure, mean pulmonary artery wedge pressure (PAWP), age, N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), mixed venous oxygen saturation (SVO2), creatinine, and presence of ischemic cardiomyopathy. Mean, diastolic, and systolic PA pressure, mean right atrial pressure, mean PAWP, SVO2 and cardiac index were significant predictors for the primary endpoint reached by 467/883 (53%) patients, in a multiple Cox proportional hazards model ( p < 0.001). The predictive value was diminished in a subgroup of patients with ischemic cardiomyopathy. We used invasive parameters, age, NT-proBNP, hsTnT , creatinine presence of ischemic cardiomyopathy and sex to develop a new model for risk stratification. This new score showed better performance compared to the SHFM and MAGGIC score in predicting the primary endpoint at 6, 12 and 24 months (area under the curve 0.76, 0.78 and 0.77 vs 0.71/0.69, 0.70/0.68 and 0.70/0.70). Conclusion Invasive hemodynamics provides valuable measurements for predicting outcome in heart failure with reduced ejection fraction and show better performance than established risk models when combined with cardiac biomarkers and other clinical variables in this particular cohort.
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Kraus et al. (2025) conducted a cohort in Heart failure with reduced ejection fraction (n=883). Invasive hemodynamics-based risk score vs. Seattle Heart Failure Model (SHFM) and MAGGIC Score was evaluated on Combined endpoint of all-cause mortality, heart transplantation, or left ventricular assist device implantation (AUC 0.78 at 12 months, p=<0.001). A new risk score incorporating invasive hemodynamics and cardiac biomarkers demonstrated better performance than the SHFM and MAGGIC scores in predicting the combined endpoint of mortality, heart transplantation, or LVAD implantation at 12 months (AUC 0.78 vs 0.70 and 0.68).
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