Abstract 4137198: Cardiac Index At The Time Of Pulmonary Artery Pressure Monitor Implantation And Inotrope Requirement Within 1 Year

Introduction: Pulmonary artery pressure monitoring with an implantable device (PAPM) improves heart failure hospitalizations (HFH) in patients with symptomatic heart failure. We sought to explore whether cardiac index (CI) predicted need for initiation of inotrope within 1 year of PAPM. Purpose: To examine the association between CI at PAPM implantation and need for inotropes within 1 yr. Methods: We retrospectively analyzed 277 consecutive HF patients who underwent PAPM from 1/1/19 through 10/31/22 with at least 1 yr post-implant follow-up. Demographic and clinical characteristics were compared between those who required inotropes within 1 yr (n=60) vs those who did not (n=217) (Figure 1). Independent samples t-test was used for continuous data and chi-square analysis for categorical data. Logistic regression was used to examine CI as a predictor of inotrope requirement within 1 yr, controlling for age, ejection fraction and glomerular filtration rate. Results: The average age was 69 (12) yr, 54% were male and 60 required inotropes. Patients requiring inotropes had significantly lower CI (2.2±0.6 L/min/m 2 vs 2.6±0.7 L/min/m 2 , p < 0.001). CI was a significant independent predictor of inotrope requirement within 1 yr [odds ratio (OR)=0.3, 0.2-0.6; P<.001). Every increase in CI by 1 L/min/m 2 resulted in 70% lower odds of requiring inotropes (Figure 2). After adjustment, CI remained a significant predictor of inotrope need (OR=0.4, 0.2-0.7; p<0.001); every increase in CI by 1 L/min/m 2 reduced odds of inotrope requirement by 60%. Conclusion: Lower cardiac index at the time of PAPM implantation in symptomatic heart failure patients was associated with an increased need for inotrope within one year. This may identify a cohort of patients at risk of progressing to advanced heart failure. Prospective studies should examine the role of PAPM in management of HF patients with a low presenting cardiac index as well as patients with a PAPM and on inotrope.