Right Atrial to Pulmonary Capillary Wedge Pressure Ratio Is Not Associated with Failure of Optimal Medical Management in the INTERMACS 4-5 Population

Abstract

Purpose Intracardiac filling pressures play an important role in in risk stratification of patients with advanced systolic heart failure (HF) undergoing cardiac transplantation (OHT) and left ventricular assist device (LVAD) placement. The right atrial (RA) pressure to pulmonary capillary wedge pressure (PCWP) ratio has been shown to have important prognostic significance. Less is known about the prognostic impact of cardiac filling pressures in patients with ambulatory advanced HF (INTERMACS profiles 4-5). Methods and Materials We retrospectively evaluated 187 patients referred for consideration of advanced HF therapies at our center from January 2005 to July 2010. The endpoint of failure of optimal medical management (OMM) was defined as death, OHT or LVAD implantation. Tertiles of RA:PCWP ratio were defined as 0.583(tertile 3). Median PCWP in each cohort was 16, 25, and 20 mmHg respectively (p Results Patients in tertile 3 had lower PA oxygen saturation(p= 0.006), RV stroke work index (p 20mmHg, p=0.146). However, when evaluating each RA and PCWP independently, only increasing PCWP was associated with failure of OMM [HR 1.046 (1.020-1.073), p Conclusions In a cohort of patients with advanced ambulatory HF (INTERMACS 4-5), increasing RA:PCWP was associated with worsening RV function and decreased exercise capacity but not with failure of OMM. PCWP varied across tertiles of RA:PCWP ratio and was independently associated with failure of OMM. Our study suggests that left and right-sided filling pressures may need to be interpreted independently in advanced ambulatory heart failure.