Risk Stratification with Haemodynamic Gain Index and Peak Rate-Pressure Product in Patients with Chronic Heart Failure Undergoing Treadmill Exercise Testing.

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We recently demonstrated the combined prognostic value of two simple non-invasive parameters obtained from treadmill exercise testing in patients with heart failure (HF) with reduced ejection fraction, the haemodynamic gain index (HGI) and peak rate-pressure product (RPP). However, their prognostic value is yet to be validated in patients with undifferentiated HF syndrome. We identified consecutive HF patients undergoing treadmill exercise testing for symptom evaluation between 1/1991-2/2015. HGI was calculated from [(SBPpeak x heart ratepeak) - (SBPrest x heart raterest)]/(SBPrest x heart raterest), and peak RPP was calculated from SBPpeak x heart ratepeak. Hazard ratios per doubling of HGI and peak RPP for all-cause mortality were estimated using multivariable Cox regression models with adjustment for traditional cardiovascular risk factors and exercise testing parameters (chronotropic reserve index, estimated metabolic equivalents, abnormal heart rate recovery, and total exercise time). In our cohort of 5,940 patients with symptomatic HF diagnosis with median follow up of 7.1 years, 2,222 (37.4%) patients died. Higher both HGI and peak RPP were associated with a lower risk of mortality (adjusted hazard ratio per standard deviation increase 0.80 [0.73-0.88] and 0.85 [0.78-0.91], respectively, all p<0.001). Optimal cut-off values for HGI and peak RPP for discriminating all-cause mortality were 1.06 and 18,966, respectively. Both HGI and peak RPP are predictors of mortality in patients with chronic HF and may be tools to signal need for advanced HF therapy evaluation.