The Prognostic Significance of Invasive Hemodynamic Variables in Ambulatory Patients with Heart Failure

AbstractBackground Invasive hemodynamic assessment is often performed in patients with heart failure (HF) but the relative prognostic utility of markers of congestion versus flow remains largely unknown. Objective We studied the association between hemodynamic variables obtained during right heart catheterization (RHC) and outcomes in an ambulatory HF cohort with mixed etiologies. Methods The study population included consecutive adult patients who underwent elective RHC for the diagnosis or management of HF at Vanderbilt University Medical Center. Patients with a history of heart transplant or left ventricular assist device (LVAD), or those that subsequently received these therapies during the study period, were excluded. The primary outcome was 12-month mortality. Logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI) values for relevant variables to construct a multivariable model. Results A total of 276 patients underwent elective RHC during the study period; 18 patients died and 37 required escalation to heart transplantation or LVAD during 12-month follow-up. Both markers of systemic flow (cardiac index and aortic pulsatility index) and congestion (central venous pressure, and pulmonary capillary wedge pressure) were associated with 12-month mortality on a univariate analysis. Following multivariable analysis, factors associated with 12-month mortality were chronic kidney disease (OR 7.21, 95% CI 1.51-34.43, p=0.005), cardiac index (OR 0.133 per L/min/m2 increase, 95% CI 0.024-0.73 p=0.011), and pulmonary vascular resistance (OR 1.342 per Wood Unit increase, 95% CI 1.04-1.73, p=0.007). Conclusion In an ambulatory, mixed HF cohort, Cardiac Index and Pulmonary Vascular Resistance were the only hemodynamic variables independently associated with 12-month mortality following a multivariable analysis