Hemodynamic Evolution of Heart Failure from Hypertension: Lower Stroke Volume Index and Higher Heart Rate

BACKGROUND: There is little information about systemic hemodynamic changes in the evolution of heart failure (HF) from hypertension. METHODS: We compared 24-hr mean hemodynamic variables derived from ambulatory pulse wave analysis (Mobil-O-Graph) in at-risk patients with hypertension (Stage A/B HF) and patients with Stage C HF secondarily stratified by ejection fraction (EF: low <40% or high ≥40%). RESULTS: Differences (mean ± SEM) between Stage A/B (n = 109) and Stage C HF (n = 52) were, respectively: stroke volume index (SVI) 36.8 vs. 31.9 mL/m2 (P<.001), heart rate (HR) 68.1 vs. 76.4 bpm (P<.001), and arterial stiffness (pulse pressure/SVI) 1.47 vs. 1.65 mmHg/mL/m2 (P<.05); cardiac index and total vascular resistance index did not differ between groups. Robust inverse correlations between SVI and HR were found in both Stage A/B and Stage C HF (P < .001); each 10 beat/min change in HR was accompanied by a reciprocal SVI change of 3 mL/m2; overall, SVI was 5-10% lower in Stage C compared to Stage A/B HF. Hemodynamic profiles, especially high HR and low SVI, were quantitatively similar in Stage C HF patients with low or high EF. Low SVI (<35 mL/min/m2) conferred a specificity for Stage C HF of 71%; adding high HR (>75 bpm) increased specificity to 84%. CONCLUSIONS: Ambulatory hemodynamic monitoring is feasible in HF patients; low 24-hour SVI and high HR are highly correlated and together can differentiate Stage C from Stage A/B HF, irrespective of EF. Further study of hemodynamic profiles in HF staging and prognosis is warranted.