Abstract 12407: A Comparison of Hemodynamic and Cardiopulmonary Exercise Stress Variables for Advanced Heart Failure Prognosis

Abstract

Introduction: Both invasive hemodynamics as measured by right heart catheterization (RHC) and cardiopulmonary exercise testing (CPET) are used for prognostication in advanced heart failure patients. We aimed to compare the prognostic performance of these variables in patients with advanced heart failure with a particular focus on defining the incremental prognostication of advanced hemodynamic metrics compared to CPET variables. Methods: We retrospectively analyzed patients who underwent both a RHC and CPET within one year of each other from January 2013 to January 2019 at our institution. The CPET variables of peak oxygen consumption (VO2), minute ventilation/carbon dioxide production (VE/VCO2), oxygen pulse (VO2/HR), and the RHC variables of left ventricular stroke work index (LVSWI), cardiac power output (CPO), and aortic pulsatility index (API) were used. The primary outcome was death, left ventricular assist device, or heart transplant at one year following the RHC. Results: A total of 55 patients were included in the analysis: 35% women, 51% Black, and 27% ischemic cardiomyopathy. Overall, using Spearman’s analysis, there were no significant correlations between the RHC and CPET variables. On Kaplan-Meier analysis, lower LVSWI was significantly associated with the primary outcome when compared to lower VO2/HR, HR 5.3 (95% CI 1.2-23, p = 0.02.), lower VE/VCO2, HR 3.7 (95% CI 1.3-10.4, p = 0.014), and lower peak VO2, HR 7.0 (95% CI 0.9-56, p = 0.06). Conclusion: LVSWI is more associated with one-year outcomes in patients with advanced heart failure than other prognostic hemodynamic or CPET variables. Furthermore, advanced hemodynamic metrics are more prognostic than CPET measurements when these values are discordant.