Abstract 4142413: Left-Sided and Right-Sided Composite Advanced Hemodynamic Metrics for Prognostication in Heart Failure

A complete invasive hemodynamic assessment, including both standard and advanced hemodynamic parameters improves risk stratification in patients with heart failure. Specifically, the novel advanced hemodynamic parameters, aortic pulsatility index (API) and cardiac power output (CPO), have shown robust prognostic potential in patients with cardiogenic shock and advanced heart failure. However, the incremental benefit of a simultaneous utilization of composite advanced hemodynamic parameters across the spectrum of left- and right- sided dysfunction currently remains unknown. We performed a retrospective study of all patients with heart failure undergoing isolated right heart catheterization at our institution from 2013 to 2019. API, pulmonary artery pulsatility index (PAPI), as well as right and left ventricular CPO (RV-CPO, LV-CPO, respectively) were measured; RV CPO = (mPAP - RAP) * CO / 451. The primary outcome was freedom from left ventricular assist device (LVAD), orthotopic heart transplant (HT), and death at 24 months. Kaplan-Meier analyses were conducted based on previously determined cutpoints from receiver operator characteristic curve analysis. A total of 709 patients were included (60 ± 14 years, 46% women, and 40% ischemic cardiomyopathy). There were 297 (42%) primary events in this cohort over 24 months: 46 LVAD, 38 HT, and 213 deaths. The left-sided parameters (API and LV-CPO) proved the primary drivers of the diversion in outcomes in all analyses (p <0.05). RV-CPO showed additional risk stratification when combined with either API or LV-CPO analyses, but only in patients with normal-range values (i.e. API ≥1.45 and LV CPO ≥0.64, p<0.05). No other composite markers showed prognostic significance (Figure). Prognosis at 24 months for patients with heart failure was most sensitive to left-sided advanced hemodynamic parameters (i.e. API and LV-CPO), though RV-CPO, a right sided parameter, provided some additional prognostic benefit in those with a normal left-sided parameter.