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Cardiac index predicts long-term outcomes in patients with heart failure
Tatsuro Ibe1, Hiroshi Wada1, Kenichi Sakakura1
1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Insights
Reduced cardiac index (CI) and elevated right atrial pressure (RAP) significantly increase major adverse cardiovascular events in heart failure patients. Low CI independently predicts poor long-term cardiac outcomes, aiding risk stratification.
Area of Science:
- Cardiology
- Heart Failure Research
- Hemodynamics
Background:
- The prognostic value of cardiac index (CI) and right atrial pressure (RAP) in long-term heart failure outcomes remains unclear.
- This study investigates the combined impact of CI and RAP on cardiac outcomes in heart failure patients.
Purpose of the Study:
- To evaluate the association between different combinations of CI and RAP and long-term cardiac outcomes.
- To determine the predictive value of CI and RAP for major adverse cardiovascular events (MACE) in heart failure.
Main Methods:
- Retrospective analysis of 787 heart failure patients undergoing right-heart catheterization.
- Patients categorized into four groups based on preserved/reduced CI (≥2.5 L/min/m² / <2.5 L/min/m²) and low/high RAP (<8 mmHg / ≥8 mmHg).
- Survival analysis used to assess MACE risk across the four defined hemodynamic groups.
Main Results:
- Both reduced CI groups (RED-CI/L-RAP and RED-CI/H-RAP) showed significantly higher MACE rates compared to preserved CI groups (PRE-CI/L-RAP and PRE-CI/H-RAP) after adjusting for confounders.
- No significant difference in MACE was observed between the RED-CI/H-RAP and RED-CI/L-RAP groups.
- Hazard ratios indicated increased MACE risk for patients with reduced CI, irrespective of RAP levels.
Conclusions:
- Hemodynamic severity, defined by CI and RAP, effectively stratifies risk in symptomatic heart failure patients.
- Low cardiac index is an independent predictor of adverse long-term cardiac outcomes in heart failure.
- Combined assessment of CI and RAP provides valuable prognostic information for heart failure management.
Background:
The role of cardiac index (CI) and right atrial pressure (RAP) for predicting long-term outcomes of heart failure has not been well established. The aim of this study was to investigate long-term cardiac outcomes in patients with heart failure having various combinations of CI and RAP.
Methods:
A total of 787 heart failure patients who underwent right-heart catheterization were retrospectively categorized into the following four groups: Preserved CI (≥2.5 L/min/m2) and Low RAP (<8 mmHg) (PRE-CI/L-RAP; n = 285); Preserved CI (≥2.5 L/min/m2) and High RAP (≥8 mmHg) (PRE-CI/H-RAP; n = 242); Reduced CI (<2.5 L/min/m2) and Low RAP (<8 mmHg) (RED-CI/L-RAP; n = 123); and Reduced CI (<2.5 L/min/m2) and High RAP (≥8 mmHg) (RED-CI/H-RAP; n = 137). Survival analysis was applied to investigate which groups were associated with major adverse cardiovascular events (MACE).
Results:
The RED-CI/L-RAP and RED-CI/H-RAP groups were significantly associated with MACE as compared with the PRE-CI/L-RAP and PRE-CI/H-RAP groups after adjustment for confounding factors (RED-CI/L-RAP vs. PRE-CI/L-RAP: HR 2.11 [95% CI 1.33-3.37], p = 0.002; RED-CI/H-RAP vs. PRE-CI/L-RAP: HR 2.18 [95% CI 1.37-3.49], p = 0.001; RED-CI/L-RAP vs. PRE-CI/H-RAP: HR 1.86 [95% CI 1.16-3.00], p = 0.01; RED-CI/H-RAP vs. PRE-CI/H-RAP: HR 1.92 [95% CI 1.26-2.92], p = 0.002), whereas the difference between the RED-CI/H-RAP and RED-CI/L-RAP groups was not significant (HR 1.03 [95% CI 0.64-1.66], p = 0.89).
Conclusions:
The hemodynamic severity categorized by CI and RAP levels provided clear risk stratification in patients with symptomatic heart failure. Low CI was an independent predictor of long-term cardiac outcomes.
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