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Hemodynamic Gain Index Is Associated With Cardiovascular Mortality and Improves Risk Prediction: A PROSPECTIVE COHORT

Jari A Laukkanen1, Nzechukwu M Isiozor, Peter Willeit

  • 1Central Finland Health Care District Hospital District, Department of Medicine, Finland District, Jyväskylä, Finland, and Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland (Dr Laukkanen); Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland (Drs Laukkanen and Isiozor); Clinical Epidemiology Team, Medical University of Innsbruck, Innsbruck, Austria, and Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (Dr Willeit); and Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, United Kingdom, and National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom, and Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, United Kingdom (Dr Kunutsor).

Journal of Cardiopulmonary Rehabilitation and Prevention
|March 3, 2023
PubMed

Insights

The hemodynamic gain index (HGI) is linked to lower cardiovascular disease (CVD) mortality risk, though this association is partly influenced by cardiorespiratory fitness (CRF). The HGI enhances CVD risk prediction models.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Preventive Medicine

Background:

  • Cardiopulmonary exercise testing (CPX) assesses hemodynamic gain index (HGI) and cardiorespiratory fitness (CRF).
  • The relationship between HGI and cardiovascular disease (CVD) mortality remains unclear.
  • Prospective studies are needed to clarify this association.

Purpose of the Study:

  • To investigate the association between the hemodynamic gain index (HGI) and risk of cardiovascular disease (CVD) mortality.
  • To determine if HGI improves CVD mortality risk prediction.
  • To evaluate the independent and combined roles of HGI and cardiorespiratory fitness (CRF) in CVD mortality.

Main Methods:

  • A prospective study involving 1634 men aged 42-61 years undergoing CPX.
  • HGI calculated using heart rate (HR) and systolic blood pressure (SBP) during CPX.
  • Cardiorespiratory fitness (CRF) measured directly using respiratory gas exchange analysis.

Main Results:

  • Over a median follow-up of 28.7 years, 439 CVD deaths occurred.
  • Higher HGI was associated with a continuous decrease in CVD mortality risk.
  • While HGI improved risk prediction, its association was partly explained by CRF; CRF independently predicted CVD mortality.

Conclusions:

  • Increased HGI is inversely associated with CVD mortality in a dose-dependent manner.
  • The predictive value of HGI for CVD mortality is partially dependent on CRF levels.
  • Incorporating HGI into risk models enhances CVD mortality prediction and reclassification accuracy.
Abstract

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