Abstract 9622: Baseline Hemodynamics with Cardiac Performance Response to Contrast Media During Diagnostic Cardiac Catheterization Enhances Prediction of Adverse Events in Heart Failure Patients

Abstract

Background. Anticipating adverse events (death, HF rehospitalization) in heart failure patients (HF pts) could help direct care while reducing event rates and resource utilization. We hypothesized that the combination of baseline pulmonary capillary wedge pressure (PCWP) and change in measures of cardiac performance (ΔCP) following administration of contrast media during diagnostic cardiac catheterization would predict adverse events and add to the predictive value of existing models. Methods. Prospective study of 150 consecutive HF pts referred for non-emergency right and left heart catheterization using iodixanol or iopamidol contrast. Hemodynamic variables measured at baseline and following contrast included PCWP and CP (composite of cardiac output, cardiac index and stroke volume, identified from sparse principal component analysis of all hemodynamic variables). Kaplan-Meier curves were generated for 1 year followup using median baseline PCWP and ΔCP to group pts. The effect of adding these hemodynamic parameters to the predictive value of 4 validated risk models (Seattle HF Score; ESCAPE; CHARM; CORONA) was assessed using Cox proportional hazards regression model. Results. The average contrast load was 120ml. There was a graded worsening of long-term adverse events, with event rates increasing with the composite metric (Figure). Adding baseline PCWP and ΔCP to the 4 risk models significantly improved their predictive capacity (Table). Conclusions. Baseline PCWP with change in CP following administration of contrast predicts adverse events and adds to the predictive value of existing models. The calculations add no cost and can be performed in minutes.