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Coronary perfusion pressure is associated with adverse outcomes in advanced heart failure
Sula Mazimba1, Christiana Jeukeng2, Olivia Ondigi1
1University of Virginia Health System, Charlottesville, VA, USA.
Insights
Low coronary perfusion pressure (CPP) in advanced heart failure patients is linked to adverse outcomes. Monitoring CPP may aid in risk stratification and evaluating heart failure therapies.
Area of Science:
- Cardiology
- Hemodynamics
- Heart Failure Research
Background:
- Myocardial perfusion is critical for cardiac function.
- Low coronary perfusion pressure (CPP) may indicate inadequate myocardial perfusion during increased cardiac demand in heart failure.
- This study investigated the association between CPP and adverse outcomes in advanced heart failure.
Purpose of the Study:
- To determine if low coronary perfusion pressure (CPP) is associated with adverse outcomes in patients with advanced heart failure.
- To explore the utility of CPP in risk stratification and therapy evaluation for heart failure.
Main Methods:
- Analysis of hemodynamic data from 158 patients in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial.
- Cox Proportional Hazards regression was used to assess the composite risk of death, heart transplantation, or left ventricular assist device (LVAD) implantation, and heart failure hospitalization.
- Coronary perfusion pressure (CPP) was calculated as diastolic blood pressure minus pulmonary artery wedge pressure.
Main Results:
- A median CPP of 40 mmHg was observed.
- Higher CPP was significantly associated with a lower risk of the primary composite outcome (death, transplantation, or LVAD) (HR 0.96, p = .002).
- Higher CPP was also associated with a lower risk of the secondary composite outcome including heart failure hospitalization (p = .0008).
- A significant interaction was found between CPP and ischemic etiology (p = .04).
Conclusions:
- Low coronary artery perfusion pressure (CPP) below 40 mmHg in advanced heart failure patients is associated with adverse outcomes.
- CPP monitoring may be valuable for risk stratification in advanced heart failure.
- CPP could assist in the timely evaluation of therapies for advanced heart failure.
Background:
Myocardial perfusion is an important determinant of cardiac function. We hypothesized that low coronary perfusion pressure (CPP) would be associated with adverse outcomes in heart failure. Myocardial perfusion impacts the contractile efficiency thus a low CPP would signal low myocardial perfusion in the face of increased cardiac demand as a result of volume overload.
Methods:
We analyzed patients with complete hemodynamic data in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial using Cox Proportional Hazards regression for the primary outcome of the composite risk of death, heart transplantation, or left ventricular assist device [(LVAD). DT × LVAD] and the secondary outcome of the composite risk of DT × LVAD and heart failure hospitalization (DT × LVADHF). CPP was calculated as the difference between diastolic blood pressure and pulmonary artery wedge pressure. Heart failure categories (ischemic vs non-ischemic) were also stratified based on CPP strata.
Results:
The 158 patients (56.7 ± 13.6 years, 28.5% female) studied had a median CPP of 40 mmHg (IQR 35-52 mmHg). During 6 months of follow-up, 35 (22.2%) had the composite primary outcome and 109 (69.0%) had the composite secondary outcome. When these outcomes were then stratified based on the median, CPP was associated with these outcomes. Increasing CPP was associated with lower risk of both the primary outcome of DT × LVAD (HR 0.96, 95% CI 0.94-0.99 p = .002) and as well as the secondary outcome of DT × LVADHF (p = .0008) There was significant interaction between CPP and ischemic etiology (p = .04).
Conclusion:
A low coronary artery perfusion pressure below (median) 40mmHg in patients with advanced heart failure undergoing invasive hemodynamic monitoring with a pulmonary artery catheter was associated with adverse outcomes. CPP could useful in guiding risk stratification of advanced heart failure patients and timely evaluation of advanced heart failure therapies.
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