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Comparison of Hemodynamic Factors Predicting Prognosis in Heart Failure: A Systematic Review
1Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. m.b.aalders@amsterdamumc.nl.
Insights
In heart failure, higher pulmonary capillary wedge pressure (PCWP) and lower systolic blood pressure (SBP) predict poor prognosis. Cardiac index (CI) is not an independent predictor.
Area of Science:
- Cardiology
- Clinical Research
- Prognostic Studies
Background:
- Hemodynamic factors are crucial in heart failure (HF) management.
- Understanding the prognostic significance of cardiac output, preload, and afterload is essential for patient care.
Purpose of the Study:
- To systematically compare the prognostic predictive power of cardiac output (cardiac index, CI), preload (pulmonary capillary wedge pressure, PCWP), and afterload (systolic blood pressure, SBP) in heart failure patients.
- To determine which hemodynamic factor is the best predictor of prognosis in HF.
Main Methods:
- Systematic literature review of prognostic studies in heart failure.
- Inclusion criteria required studies to assess at least two of three hemodynamic variables: CI, PCWP, and SBP.
- Critical appraisal using the QUIPS tool; main endpoint was all-cause mortality.
Main Results:
- Eighteen studies with multivariate analysis were included.
- Pulmonary capillary wedge pressure (PCWP) was a significant predictor in 10 studies.
- Systolic blood pressure (SBP) was a predictor in 3 studies, while cardiac index (CI) was not a significant predictor in any study.
Conclusions:
- Elevated PCWP and reduced SBP are independent predictors of poor prognosis in heart failure.
- Cardiac index (CI) does not independently predict prognosis in HF, contrary to common assumptions.
Objectives:
We systematically reviewed the literature to address the question of which of the three hemodynamic factors predicts prognosis best in heart failure patients when directly compared to each other: cardiac output, preload or afterload.
Methods:
Prognostic studies in heart failure (HF) were searched that included at least two of the three hemodynamic variables: (1) cardiac output or cardiac index (CI), (2) preload represented by pulmonary capillary wedge pressure (PCWP) and (3) afterload simplified to systolic blood pressure (SBP). Critical appraisal was done according to the QUIPS format for prognostic studies. The main endpoint was all-cause mortality, which could be combined with other endpoints. We report the number of studies in which CI, PCWP and SBP remained significant prognostic predictors in multivariate analysis. We also assessed whether hemodynamic predictors of prognosis varied in four different HF-populations.
Results:
Included were 18 studies containing a multivariate analysis. PCWP was an independent predictor of prognosis in 10 of 18 studies, SBP in 3 of 14 studies and CI in none of 18 studies. Results were not specific for any of the HF-populations.
Conclusions:
A higher PCWP and lower SBP are independent predictors of poor prognosis in HF. In spite of the frequently used concept behind HF, this review demonstrates that CI is not an independent predictor of prognosis in HF.
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