Abstract 4146133: The prognostic impact of energetic hemodynamics on acute heart failure

Background: Central aortic hemodynamics significantly affect left ventricular function and clinical outcomes in patients with heart failure (HF). We proposed that energetic hemodynamic parameters could offer a more detailed understanding and a stronger correlation with left ventricular function and outcomes, compared to traditional pressure-based parameters. Methods: A total of 166 patients (61 years, 26.5% women) hospitalized due to HF (24% with preserved systolic function) were enrolled. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured at admission. At discharge, we assessed the augmentation index (AI), backward pressure (Pb) and carotid-femoral pulse wave velocity (cf-PWV) using tonometry, as well as aortic doppler flow. Energetic hemodynamic parameters were calculated by integrating pressure multiplied by flow over time. Results: While subjects with a left ventricular ejection fraction (LVEF) <50% exhibited significantly lower AI and Pb compared to those with LVEF of ≥50%, aortic and carotid energetic hemodynamic parameters were also significantly lower in patients with impaired LVEF. After adjusting for age, sex, estimated glomerular filtration rate, and NT-proBNP, the total and mean energy of the carotid artery were independently associated with mortality [hazard ratios and 95% confidence intervals: 1.009 (1.004-1.015) and 1.018 (1.006-1.026), respectively]. Subgroup analyses consistently demonstrated the prognostic value of energetic hemodynamics across different HF phenotypes. Conclusion: The study indicated that energetic hemodynamic parameters, especially the total and mean energy of the carotid artery, correlated with long-term survival, irrespective of LVEF. Notably, these energetic hemodynamics surpassed cf-PWV in their correlation with left ventricular systolic function.