Key result
Increasing coronary perfusion pressure was associated with a lower risk of death, heart transplantation, or LVAD in patients with advanced heart failure (HR 0.96; 95% CI 0.94-0.99; p=0.002).
Why the study?
Myocardial perfusion is an important determinant of cardiac function, leading to the hypothesis that low coronary perfusion pressure would be associated with adverse outcomes in heart failure.
Does higher coronary perfusion pressure reduce the composite risk of death, heart transplantation, or LVAD in patients with advanced heart failure?
Cohort (n=158)
Does higher coronary perfusion pressure reduce the composite risk of death, heart transplantation, or LVAD in patients with advanced heart failure?
Hazard Ratio: 0.96 (95% CI 0.94–0.99)
p-value: p=0.002
In patients with advanced heart failure, lower coronary perfusion pressure is significantly associated with an increased risk of death, heart transplantation, or LVAD implantation.
Low CPP may flag higher-risk HF; hypothesis-generating and requires prospective validation before any therapeutic targeting.
Background Myocardial perfusion is an important determinant of cardiac function. We hypothesized that low coronary perfusion pressure (CPP) would be associated with adverse outcomes in heart failure. Myocardial perfusion impacts the contractile efficiency thus a low CPP would signal low myocardial perfusion in the face of increased cardiac demand as a result of volume overload. Methods We analyzed patients with complete hemodynamic data in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial using Cox Proportional Hazards regression for the primary outcome of the composite risk of death, heart transplantation, or left ventricular assist device [(LVAD). DT × LVAD] and the secondary outcome of the composite risk of DT × LVAD and heart failure hospitalization (DT × LVADHF). CPP was calculated as the difference between diastolic blood pressure and pulmonary artery wedge pressure. Heart failure categories (ischemic vs non-ischemic) were also stratified based on CPP strata. Results The 158 patients (56.7 ± 13.6 years, 28.5% female) studied had a median CPP of 40 mmHg (IQR 35–52 mmHg). During 6 months of follow-up, 35 (22.2%) had the composite primary outcome and 109 (69.0%) had the composite secondary outcome. When these outcomes were then stratified based on the median, CPP was associated with these outcomes. Increasing CPP was associated with lower risk of both the primary outcome of DT × LVAD (HR 0.96, 95% CI 0.94–0.99 p = .002) and as well as the secondary outcome of DT × LVADHF ( p = .0008) There was significant interaction between CPP and ischemic etiology ( p = .04). Conclusion A low coronary artery perfusion pressure below (median) 40mmHg in patients with advanced heart failure undergoing invasive hemodynamic monitoring with a pulmonary artery catheter was associated with adverse outcomes. CPP could useful in guiding risk stratification of advanced heart failure patients and timely evaluation of advanced heart failure therapies.
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Mazimba et al. (2022) conducted a cohort in Advanced heart failure (n=158). Coronary perfusion pressure vs. Lower coronary perfusion pressure was evaluated on Composite risk of death, heart transplantation, or left ventricular assist device (HR 0.96, 95% CI 0.94-0.99, p=0.002). Increasing coronary perfusion pressure was associated with a lower risk of death, heart transplantation, or LVAD in patients with advanced heart failure (HR 0.96; 95% CI 0.94-0.99; p=0.002).
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