Organ perfusion pressure at admission and clinical outcomes in patients hospitalized for acute heart failure

Abstract

Abstract Background Hypoperfusion portends adverse outcomes in acute heart failure (AHF). The gradient between end-organ inflow and outflow pressures may more closely reflect hypoperfusion than mean arterial pressure (MAP) alone. Purpose To investigate organ perfusion pressure (OPP), calculated as MAP minus central venous pressure (CVP), as a prognostic marker in AHF. Methods The SNIP-AHF study was a multicenter retrospective cohort study of 200 consecutive patients hospitalized for AHF treated with sodium nitroprusside. Only patients with both MAP and invasive CVP data available from the SNIP-AHF cohort were included. The primary endpoint was to assess OPP as a predictor of worsening heart failure (WHF) at 48 hours. Results 146 patients were included (mean age: 61.1±13.5 years, 32 [21.9%] females; mean left ventricular ejection fraction: 23.8%±11.4%, mean MAP: 80.2±13.2 mmHg, mean CVP: 14.0±6.1 mmHg). WHF occurred in 14 (9.6%) patients. At multivariable models including hemodynamic variables (OPP, shock index, MAP and CVP), OPP at admission was the best predictor of WHF at 48 hours (OR 0.91 [95%CI 0.86-0.96], p-value = 0.001) with an optimal cut-off value of 67.5 mmHg (specificity 47.3%, sensitivity 100%, AUC 0.784±0.054 [p-value<0.001]). In a multivariable model including univariable significant parameters available at first beside assessment, namely New York Heart Association functional class, OPP, shock index, MAP and left ventricular end-diastolic diameter, OPP significantly predicted WHF at 48 hours (OR 0.82 [95%CI 0.68-0.98], p-value=0.027). Conclusion In this retrospective analysis on patients hospitalized for AHF treated with sodium nitroprusside, on-admission OPP significantly predicted WHF at 48 hours with high sensitivity.OPP in acute heart failureMultivariable analysis on WHF