Hemodynamic variables (cardiac power) and their changes during 6 hours are the strongest predictors of short-term outcome in acute heart failure

Abstract

The use of right heart catheterization in patients admitted with acute heart failure has become infrequent, primarily since measures obtained by it were not shown to be correlated with outcome. Methods: We assessed hemodynamic and clinical variables in 120 patients admitted with acute heart failure that underwent right heart catheterization at admission. Patients were in the placebo arms of two multi-center international studies. Patients were followed for 30 days. Cardiac power (Cp) was calculated as CO ∗mean arterial blood pressure (MAP) and expressed in Watt units. The main outcome measure examined in this study was recurrent worsening heart failure (WHF) from admission until 30 days of follow up. WHF was defined as recurrent symptoms and signs of heart failure, pulmonary edema or cardiogenic shock after initial stabilization or failure to improve during the first 24 hours of treatment. Results: WHF occurred in 45% of the study population. The hemodynamic variables Cp and its 6-hours change as well as wedge pressure at baseline were the strongest predictors of WHF and death in the present cohort. The combination of Cpo<0.6 watt at baseline and Cpo decrease at 6 hours monitoring or Cpo>0.6 watt at baseline and Cpo increase at 6 hours of monitoring predicted most of the adverse outcome in the present study (Table). WHF was the strongest predictor of mortality in the present cohort. Conclusion: Short term (6-hours) hemodynamic monitoring using cardiac power and its change may have value in the risk stratification of patients with acute heart failure, while CO and wedge pressure measurement alone do not predict patients' outcome.Predictors of 30 days WHF and DeathWHF 7 DaysWHF 30 DaysDeath 30 DaysOR95% CIOR95% CIOR95% CICpo <0.6 watt and Cpo↓ at 6 hours5.11.9–13.98.52.6–27.33.41.2–21.5Cpo:> 0.6 watt and Cpo↑ at 6 hours0.330,13–0.890.290.11–0.750.40.32–0.92Wedge>25 mmHg2.11.15–2.8NSNSResp Rate>24/minNSNS2.21.2–3.62Sodium<138NSNS1.91.3–4.1WBC>8,0002.71.1–6.5NSNSRight Ventricukar Paceing1.81.1–832.31.2–5.96.11.3–29.5