Abstract 16043: Pulmonary Artery Proportional Pulse Pressure Predicts Adverse Clinical Outcomes in Advanced Heart Failure

Abstract

Introduction: There is increasing interest in ventriculo-arterial hemodynamics in heart failure (HF). Hypothesis: Based on the normal physiological distribution of Pulmonary artery (PA) systolic pressure (PASP) being more than twice the PA diastolic pressure (PADP), we hypothesized that PA proportional pressure (PAPP), defined as (PASP-PADP)/PASP, would be associated with clinical outcomes using data from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Methods: Multivariable Cox proportional hazards and logistic regression was performed using independent covariates of creatinine at discharge, PAPP, and pulmonary capillary wedge pressure (PCWP) (based on final hemodynamic measurement) for the 6-month outcome of death, transplant, left ventricular assist device (LVAD), or rehospitalization (DTxLVADHF), as well as secondary outcomes of death alone and death, transplant, or LVAD (DTxLVAD). Results: Among n=175 patients, there were 110 (62.9 %) and 65 (37.1%), respectively, with optimal PAPP (> 0.50) and non-optimal PAPP (<=0.50). During 6 months of follow-up, 15.5% and 33.9%, respectively, died in these 2 groups (p=0.008). In Cox models adjusted for final PCWP and creatinine at discharge, an increase of 0.10 in the final PAPP (continuous variable, range 0-1) was associated with a 26.4% reduction in DTxLVADHF (HR 0.736, 95% CI = 0.592-0.913). Furthermore, non-optimal PAPP status was associated with increased risk for the outcomes of DTxLVADHF, DTxLVAD, and death alone with hazard ratios of 1.82 (95% CI 1.22-2.73), 2.09 (95% CI 1.09-4.02), and 2.72 (95% CI 1.29-5.72), respectively. The AUC obtained with multivariable logistic regression for the outcome of death with the model containing final PAPP, final PCWP, and creatinine at discharge was 0.804 (p<0.0001), with p< 0.05 for the odds ratios of each covariate in the model. Conclusions: PAPP at final hemodynamic measurement in patients undergoing hemodynamically guided therapy for ADHF is strongly associated with adverse clinical outcomes even after adjustment for final PCWP and creatinine at discharge. These results have important clinical implications for hemodynamic targets in patients treated for ADHF.