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

<h2>Abstract</h2><h3>Background</h3> 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. <h3>Objective</h3> We studied the association between hemodynamic variables obtained during right heart catheterization (RHC) and outcomes in an ambulatory HF cohort with mixed etiologies. <h3>Methods</h3> 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<b>.</b> <h3>Results</h3> 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). <h3>Conclusion</h3> 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