Combined Hemodynamic Measures of Left and Right Ventricular Function Predict Clinical Outcomes the ESCAPE Trial

Abstract

<h3>Purpose</h3> We evaluated the utility of combined assessment of left and right ventricular function for prediction of clinical outcomes in hospitalized heart failure patients. <h3>Methods</h3> The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial individual-level data were used. Aortic pulsatility index (API), (systolic - diastolic blood pressure)/pulmonary capillary wedge pressure, and pulmonary artery pulsatility index (PAPI), (systolic pulmonary arterial pressure - diastolic pulmonary arterial pressure)/right atrial pressure, were computed from the final hemodynamic measurements. Participants were grouped as: Low API/Low PAPI, Low API/High PAPI, High API/Low PAPI, and High API/High PAPI based on cut-points of 2.9 and 2.6 for API and PAPI, respectively, which were previously determined by our group using receiver operator characteristic analysis. The primary outcome was need for left ventricular assist device or heart transplant, or death at six-months post-hospital discharge. Secondary outcomes included any rehospitalization and cardiac rehospitalization. <h3>Results</h3> Of 433 participants enrolled in the ESCAPE trial, 142 had complete final hemodynamic data with which to calculate API and PAPI. Low API/Low PAPI was associated with the primary outcome when compared to the 3 other groups, HR 3.58 (95%CI 1.95-6.57), p<0.0001). Kaplan-Meier analysis indicated more participants with Low API/Low PAPI achieved the primary outcome (56.4% vs 19.4%, p<0.0001). Low API/Low PAPI was associated with higher risk of any rehospitalization (HR 1.64, 95%CI 1.05-2.57, p=0.031) or cardiac rehospitalization (HR 2.43, 95%CI 1.08-2.99, p=0.023) when compared to the 3 other groups. <h3>Conclusion</h3> Combined measurements of left and right ventricular function using API and PAPI is associated with significant clinical outcomes in patients hospitalized with acute decompensated heart failure, and may be useful for prognostic risk stratification.