Right heart catheterization in advanced systolic heart failure. What are the most useful haemodynamic parameters for risk stratification?

Abstract

Background: Previous studies have shown that pulmonary hypertension is a predictor of mortality in patients with systolic heart failure (SHF). Persistent pulmonary hypertension after a reactivity test is associated with a worse outcome after transplantation. Recent studies have shown the utility of different haemodynamic parameters.

Aims: To define best haemodynamic parameters for risk stratification in patients with advanced systolic heart failure.

Methods: We included 425 consecutive patients who underwent a right heart catheterization with an inotropic challenge if indicated.

Results: During a median (interquartile range) follow-up of 1.67 (0.49-4.49) years, there were 151 major cardiac events (126 cardiovascular deaths and 25 postoperative deaths after ventricular assist device implantation or heart transplantation). The most powerful independent predictors of major cardiac events were baseline right atrial pressure (RAP) (hazard ratio [HR]: 1.09, 95% confidence interval [CI]: 1.06-1.12; P<0.0001) and baseline pulmonary vascular resistance (PVR) (HR: 1.10; 95% CI: 1.03-1.17; P=0.002). After inotropic challenge, the only independent predictor was mean pulmonary arterial pressure (mPAP) (HR: 1.06; 95% CI: 1.03-1.09; P<0.0001). The combination of PVR (≤or>3 Wood units), RAP (<or≥9mmHg) and mPAP after the inotropic challenge (≤or>30mmHg) was the best predictor of major events.

Conclusion: We suggest using a simple algorithm based on baseline PVR, baseline RAP and mPAP after the inotropic challenge for the risk stratification of stable patients with advanced systolic heart failure.

Keywords: Advanced heart failure; Cathétérisme cardiaque droit; Heart transplantation; Hypertension pulmonaire; Insuffisance cardiaque avancée; Insuffisance cardiaque systolique; Pulmonary hypertension; Right heart catheterization; Systolic heart failure; Transplantation cardiaque.