Comparative Prognostic Value of Parameters of Pulsatile Right Ventricular Afterload in Patients With Advanced Heart Failure Awaiting Heart Transplantation
| Autor: | Francesca Rubino, Roberto Scarsini, Anna Piccoli, Livio San Biagio, Ilaria Tropea, Michele Pighi, Daniele Prati, Domenico Tavella, Gabriele Pesarini, Giovanni Benfari, Francesco Onorati, Leonardo Gottin, Giuseppe Faggian, Flavio Luciano Ribichini |
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| Rok vydání: | 2022 |
| Předmět: |
Heart Failure
Heart Ventricles Stroke Volume right ventricle Pulmonary Artery Prognosis right ventricle after load heart transplantation heart failure Ventricular Function Right Heart Transplantation Humans right ventricular after load heart failure heart transplantation Heart-Assist Devices after load Cardiology and Cardiovascular Medicine right ventricular after load |
| Zdroj: | The American journal of cardiology. 183 |
| ISSN: | 1879-1913 |
| Popis: | Right ventricular pulsatile afterload (RVPA) demonstrated a strong impact on survival of patients with advanced heart failure (HF) with reduced ejection fraction. The best prognostic parameter of RVPA is unknown. The aim of this work was to examine the prognostic relevance of pulmonary artery compliance (PAC), pulmonary artery elastance (PAE), and pulmonary artery pulsatile index (PAPi) in a consecutive cohort of patients with advanced HF evaluated for heart transplantation (HT). A total of 149 patients with end-stage HF underwent right-sided cardiac catheterization and were clinically followed up until death or any censoring events, including HT, left ventricular assist device, and hospitalization for acute HF. The primary endpoint occurred in 29 patients (19.5%) during a median follow-up time of 12 (interquartile range 3 to 34) months. This cohort presented a worse hemodynamic profile than event-free survivors. PAC1.9 mL/mm Hg (hazard ratio 3, 95% confidence interval 1.3 to 6.0, p= 0.007) and PAE0.9 mmHg/mL (hazard ratio 2.5, 95% confidence interval 1.1 to 5.2, p= 0.02) were associated with the adverse outcome. On the contrary, PAPi was not associated with the outcome. PAC demonstrated a superior predictive value for the composite adverse outcome compared with pulmonary vascular resistance (area under the curve comparison p= 0.019) and PAPi (p= 0.03) but similar compared with PAE (p= 0.19) and mean pulmonary arterial pressure (p= 0.51). PAC, but not PAE, showed incremental prognostic value compared with cardiac index (p= 0.02). In conclusion, hemodynamic indexes of RVPA are associated with worse survival in patients with end-stage HF. PAC and PAE demonstrated superior prognostic value compared with PAPi and pulmonary vascular resistance. Moreover, PAC showed incremental prognostic value compared with cardiac index in patients awaiting HT. |
| Databáze: | OpenAIRE |
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