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High-Output Heart Failure: A 15-Year Experience.
Yogesh N V Reddy1, Vojtech Melenovsky1, Margaret M Redfield1
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Journal of the American College of Cardiology
|July 30, 2016
Summary
High-output heart failure (HF), often caused by obesity or liver disease, is characterized by excessive vasodilation and increased mortality. Early diagnosis is crucial for patients with dyspnea and normal ejection fraction.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- High-output heart failure (HF) is an uncommon and poorly understood cause of cardiac failure.
- Etiologies, pathophysiology, clinical presentation, hemodynamics, and outcomes of high-output HF require further characterization.
Purpose of the Study:
- To characterize the causes, mechanisms, clinical features, hemodynamic profiles, and outcomes of high-output HF in contemporary patients.
- To identify common etiologies and associated risk factors for high-output HF.
Main Methods:
- Retrospective analysis of patients undergoing hemodynamic assessment at Mayo Clinic from 2000 to 2014.
- Comparison of patients with high-output HF (n=120) to controls (n=24) using Framingham criteria for HF, matched for age and sex.
Main Results:
- Common causes of high-output HF included obesity (31%), liver disease (23%), and arteriovenous shunts (23%).
- High-output HF patients exhibited eccentric left ventricular remodeling, elevated filling pressures, pulmonary hypertension, and increased cardiac output with similar ejection fraction compared to controls.
- Increased mortality was observed in high-output HF patients (HR: 3.4), with the poorest outcomes linked to the lowest systemic vascular resistance.
Conclusions:
- High-output HF, driven by excessive vasodilation and common comorbidities like obesity and liver disease, is a significant cause of heart failure.
- Given its high mortality and increasing prevalence, high-output HF should be considered in patients with dyspnea, congestion, and preserved ejection fraction.
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