Abstract 16789: Pulmonary-Systemic Effective Arterial Elastance Ratio is Associated With Increased Adverse Outcomes in Advanced Heart Failure

Abstract

Introduction: Advanced heart failure (HF) is characterized by ventricular arterial (VA) uncoupling and inefficient myocardial contractile mechanics. Effective arterial elastance (Ea) is a marker of total arterial load on the ventricle. There is paucity of data on the interaction between pulmonary-systemic effective arterial elastance (PSEa) [(Pulmonary systolic pressure/Stroke volume)/ (systolic blood pressure x 0.9)/Stroke volume)] with clinical outcomes in HF. Hypothesis: We hypothesized that increasing PSEa would be associated with higher adverse outcomes in patients enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Methods: Cox proportional hazards analysis and Kaplan Meier survival curves were used to assess associations between PSEa at end of pulmonary artery catheter (PAC) monitored therapy with clinical outcomes of time to death, transplant or LVAD (DTxLVAD) and time to death, transplant, LVAD or heart failure re-hospitalization (DTxLVADHF) over 6 months. Results: Among 165 patients (age 56.6 +/- 13.7 years, 29.1% female), the median PSEa ratio at the last PAC measurement was 0.48 (IQR 0.38 to 0.62). During 6 months of follow-up, PSEa ratio was significantly associated with the outcome of DTxLVAD in a Cox proportional hazards model (HR 2.18 per 0.25 increase in PSEa; 95% CI 1.41-3.37; P=0.0004), as well as the outcome of DTxLVADHF (HR 1.39 per 0.25 increase in PSEa; 95% CI 1.04-1.86; P=0.026); Kaplan-Meier curves demonstrated an increased rate of DTxLVAD in PSEa among patient in the highest quartile of PSEa (≥0.62) during follow- up period (Figure). Conclusion: PSEa is a novel marker of interventricular arterial coupling, that is associated with increased adverse events in advanced HF. These findings support further investigation of PSEa to guide risk stratification and prognosis in HF.