Predictors of Successful Response to Afterload Reduction In Low-output Heart Failure with Reduced Ejection Fraction

Abstract

Introduction Intravenous vasodilators such as sodium nitroprusside (SNP) are often used to reduce afterload in patients with acutely decompensated systolic heart failure and low cardiac output. However, there is a paucity of evidence guiding patient selection. The ability to identify patients that are most likely to respond with an improvement in cardiac output following the administration of SNP may help guide initial pharmacotherapy in the treatment of cardiogenic shock. Methods A retrospective review of patients admitted to our institution for pulmonary artery catheter (PAC) guided hemodynamic optimization of low-output HFrEF from 2018-2020 was performed. SNP response was defined as a CI > 2.2 L/min/m2 within 24 hours of initiation without the need for inotropes or mechanical circulatory support. Demographic, hemodynamic, and disease-specific variables prior to SNP initiation were compared between the two groups. The primary objective was to identify variables that predict response to SNP. Variables from the analysis were used to create a model to be utilized as a prediction assessment tool for response to SNP. Secondary endpoints compared survival, LVAD implantation, and transplantation between responders and non-responders. Results 77 patients were included for analysis, with 48 (62%) having successful response to SNP. Overall, patients with EF >20%, MAP > 80 mmHg, LVEDD 1.5 L/min/m2 on admit, and HR Conclusion We identified 5 demographic, hemodynamic, and clinical variables that were associated with a favorable response to afterload reduction in patients admitted with low-output heart failure. We created a SNP response prediction assessment model in order to help guide medication therapy for patients admitted with low-output heart failure. While our model did not predict survival or need for LVAD and transplantation in responders compared to failures with SNP therapy, utilization of this model in this patient population warrants further evaluation.