831 ECHO-API: CORRELATION WITH INVASIVE API AND PROGNOSTIC ROLE IN HEART FAILURE

Abstract

Abstract Background The benefit of invasive hemodynamic assessment in the setting of heart failure (HF) is still controversial. Increased right and left filling pressure have been shown to be associated with adverse prognosis, while reduced cardiac index (CI) has not. For this reason, novel hemodynamic indexes have been developed aiming to better describe the cardiac function in different loading conditions. In this context, the aortic pulsatility index (API) is a hemodynamic variable integrating LV function and loading condition which has the potential to better predict clinical outcome. It is calculated as systolic blood pressure (SBP) minus diastolic blood pressure (DBP) divided by pulmonary capillary wedge pressure (PCWP); the difference between SBP and DBP, known as arterial pulse pressure, correlates with SV, while PCWP is a marker of the degree of pulmonary congestion. API has been shown to predict long-term outcomes in acute decompensated HF and advanced HF cohorts. To the best of our knowledge, hemodynamically-derived API has never been compared to echocardiography-estimated API. Purpose To evaluate the accuracy of API obtained with echocardiographic methods (echo-API) compared with the invasive hemodynamic measure obtained with right heart catheterization (RHC) and to explore its prognostic role in a HF cohort. Methods Consecutive patients referred for RHC to Città della Salute e della Scienza hospital from May 2019 to August 2022 underwent complete two-dimensional echocardiographic evaluation and RHC. Patients ≥ 18 years with either acute or chronic HF, irrespective of etiology, were included. For the calculation of Echo-API PCWP was estimated using the average E/e’ ratio. The association between echo-API with MACE (composite of death, LVAD implantation or heart transplantation) at 1 year follow-up was evaluated. Results 112 patients were included in the analysis. They were mostly male, mean age was 57 years and the underlying heart disease was predominantly idiopathic dilated cardiomyopathy (32%), followed by ischemic (30%); mean LVEF was 35,07%. Mean Echo-API was 3,54. Echo-API showed a significant correlation with invasive API using the Pearson correlation coefficient (r = 0,6591, 95% CI 0,4639–0,7933, p < 0,0001) and showed a linear correlation at Bland-Altman plot. At multivariate regression analysis Echo-API was significatively associated with primary outcome (OR 0.469, 95% CI 0.26–0.84, p 0,011). Conclusions Echocardiographically-derived aortic pulsatility index can be obtained in all patients with advanced HF and shows a good correlation with invasive API; it is associated with MACE, representing a useful tool for non-invasive hemodynamic evaluation and risk stratification.