Etiology, Characteristics and Clinical Outcomes in High Output Heart Failure: A 15 Year Experience

Abstract

IntroductionHigh output heart failure (HOHF) is a poorly studied entity that is defined as clinical HF occurring with an elevated resting CI (>4 L/min/m2). HOHF has anecdotally been associated with numerous diseases but there are no studies systematically assessing its prevalence and etiology.MethodsRetrospective analysis among patients referred for RHC over a 14 year period was undertaken. HOHF was diagnosed by the presence of HF (by Framingham criteria), an elevated CI (>4 L/min/m2), and no other identifiable cause. Cases were also sub-categorized as primary left-sided HOHF (elevated PCWP) or right-sided HOHF (mean PA>25 mmHg with normal PCWP).ResultsOf 16462 RHCs performed between 2000 and 2014, 525 displayed a high CI, and from this group 154 patients were found to display HOHF. The most common etiologies included obesity, arteriovenous shunts, and liver, pulmonary or hematologic diseases (Figure 1). The median EF was 64% (IQR 55-69%). 75% had predominantly left sided HF and the remaining 25% had right sided HF. Over a median follow up of 6.2 years, there were 65 deaths (42%). Obesity-related HOHF had the best long term survival (56%), while hematologic (39%) and liver-disease associated (33%) HOHF had the worst survival (p=0.0134, Figure 1).Conclusions IntroductionHigh output heart failure (HOHF) is a poorly studied entity that is defined as clinical HF occurring with an elevated resting CI (>4 L/min/m2). HOHF has anecdotally been associated with numerous diseases but there are no studies systematically assessing its prevalence and etiology. High output heart failure (HOHF) is a poorly studied entity that is defined as clinical HF occurring with an elevated resting CI (>4 L/min/m2). HOHF has anecdotally been associated with numerous diseases but there are no studies systematically assessing its prevalence and etiology. MethodsRetrospective analysis among patients referred for RHC over a 14 year period was undertaken. HOHF was diagnosed by the presence of HF (by Framingham criteria), an elevated CI (>4 L/min/m2), and no other identifiable cause. Cases were also sub-categorized as primary left-sided HOHF (elevated PCWP) or right-sided HOHF (mean PA>25 mmHg with normal PCWP). Retrospective analysis among patients referred for RHC over a 14 year period was undertaken. HOHF was diagnosed by the presence of HF (by Framingham criteria), an elevated CI (>4 L/min/m2), and no other identifiable cause. Cases were also sub-categorized as primary left-sided HOHF (elevated PCWP) or right-sided HOHF (mean PA>25 mmHg with normal PCWP). ResultsOf 16462 RHCs performed between 2000 and 2014, 525 displayed a high CI, and from this group 154 patients were found to display HOHF. The most common etiologies included obesity, arteriovenous shunts, and liver, pulmonary or hematologic diseases (Figure 1). The median EF was 64% (IQR 55-69%). 75% had predominantly left sided HF and the remaining 25% had right sided HF. Over a median follow up of 6.2 years, there were 65 deaths (42%). Obesity-related HOHF had the best long term survival (56%), while hematologic (39%) and liver-disease associated (33%) HOHF had the worst survival (p=0.0134, Figure 1). Of 16462 RHCs performed between 2000 and 2014, 525 displayed a high CI, and from this group 154 patients were found to display HOHF. The most common etiologies included obesity, arteriovenous shunts, and liver, pulmonary or hematologic diseases (Figure 1). The median EF was 64% (IQR 55-69%). 75% had predominantly left sided HF and the remaining 25% had right sided HF. Over a median follow up of 6.2 years, there were 65 deaths (42%). Obesity-related HOHF had the best long term survival (56%), while hematologic (39%) and liver-disease associated (33%) HOHF had the worst survival (p=0.0134, Figure 1). Conclusions