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Published on: October 22, 2014
Long-term predictive value of stroke volume index obtained from right heart catheterization: Insights from the
Anthony A Bavry1, Edward Hess2, Stephen W Waldo2,3
1Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA.
Insights
Right heart catheterization stroke volume index shows a weak association with long-term mortality. Adding this hemodynamic parameter to clinical factors did not significantly improve patient outcome prediction.
Area of Science:
- Cardiology
- Clinical Hemodynamics
- Prognostic Biomarkers
Background:
- Right heart catheterization (RHC) provides hemodynamic parameters linked to short-term prognosis.
- The long-term prognostic significance of these RHC-derived parameters requires further investigation.
Purpose of the Study:
- To evaluate the association between stroke volume index (SVI) derived from RHC and long-term all-cause mortality.
- To determine if SVI improves prognostic models when combined with clinical covariates.
Main Methods:
- Retrospective cohort study of 37,209 patients undergoing RHC between 2008-2016.
- Cox proportional hazard models analyzed the relationship between SVI and all-cause mortality.
- Model discrimination was assessed using Area Under the Curve (AUC) and Integrated Discrimination Improvement (IDI).
Main Results:
- Low SVI (<35 cc/beat/m²) was associated with higher mortality (42.0% vs 33.2%).
- Adjusted analysis showed low SVI independently predicted higher mortality risk (HR 1.14; P < .001).
- SVI alone had limited predictive ability (AUC 0.56 at 3 years); combined with clinical covariates, AUC improved to 0.70, but with no meaningful improvement at 1 year (IDI=0.0021).
Conclusions:
- The long-term prognostic value of RHC-derived SVI is marginal.
- While low SVI indicates increased mortality risk, it offers limited additional prognostic discrimination when added to existing clinical parameters.
Background:
Right heart catheterization-derived hemodynamic parameters have been associated with short-term prognosis.
Hypothesis:
Hemodynamic parameters will be associated with long-term prognosis.
Methods:
Retrospective cohort study from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program included patients who underwent an index right heart catheterization between 2008 and 2016. Cox proportional hazard models were used to examine the association between stroke volume index and all-cause mortality.
Results:
For the final cohort of 37 209 patients, mean follow-up was 3.7 ± 2.5 years. All-cause mortality was 42.0% in the low (<35 cc/beat/m2 ) compared with 33.2% in the normal stroke volume index group (≥35 cc/beat/m2 ). In adjusted analysis, low stroke volume was significantly associated with higher mortality risk (HR (95% CI) 1.14 (1.10-1.18); P < .001) independent of clinical parameters. The area under the curve (AUC) for continuous measures of stroke volume index at predicting mortality in a Cox proportional hazard model was 0.56 at 3 years. When stroke volume index was combined with 14 clinical covariates, the AUC was 0.70 at 3 years. The addition of stroke volume index to these clinical covariates did not increase the discriminatory ability of the model at 1 year in a clinically meaningful way (integrated discrimination improvement index = 0.0021, 95% CI: 0.0010-0.0034).
Conclusions:
The long-term prognostic value of right heart catheterization-derived stroke volume index appears to be marginal. While there was a weak association of low stroke volume index and excess mortality, inclusion of this parameter to a set of clinical covariates did not improve prognostic discrimination.
