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Haemodynamic Gain Index Is Associated with Risk of Sudden Cardiac Death and Improves Risk Prediction: A Cohort Study
Jari A Laukkanen1,2,3, Nzechukwu M Isiozor2, Peter Willeit4,5
1Department of Medicine, Wellbeing Services County of Central Finland, Jyväskylä, Finland.
Insights
Higher Haemodynamic Gain Index (HGI) during cardiopulmonary exercise testing (CPX) is linked to reduced sudden cardiac death (SCD) risk. Cardiorespiratory fitness (CRF) is a stronger predictor of SCD than HGI.
Area of Science:
- Cardiology
- Exercise Physiology
- Preventive Medicine
Background:
- Sudden cardiac death (SCD) remains a significant cause of mortality.
- Novel hemodynamic parameters from cardiopulmonary exercise testing (CPX) may offer new insights into SCD risk.
- The Haemodynamic Gain Index (HGI) is a newly identified parameter from CPX, but its association with SCD is not well-established.
Purpose of the Study:
- To investigate the association between the Haemodynamic Gain Index (HGI) and the risk of sudden cardiac death (SCD).
- To determine if HGI improves SCD risk prediction beyond established risk factors.
- To compare the predictive value of HGI with cardiorespiratory fitness (CRF) for SCD.
Main Methods:
- A prospective cohort study involving 1897 men aged 42–61 years.
- HGI was calculated from heart rate and systolic blood pressure responses during CPX.
- Cardiorespiratory fitness (CRF) was assessed via respiratory gas exchange analysis.
- Multivariable adjusted hazard ratios (HRs) were estimated for SCD over a median follow-up of 28.7 years.
Main Results:
- A total of 205 SCD events occurred during follow-up.
- Higher HGI was associated with a reduced risk of SCD (HR: 0.84 per unit increase), though this association was attenuated after adjusting for CRF.
- Cardiorespiratory fitness (CRF) was inversely associated with SCD risk (HR: 0.85 per unit increase), remaining significant after adjustment for HGI.
- HGI improved SCD risk prediction and reclassification (C-index change = 0.0096, NRI = 39.40%).
- CRF demonstrated a greater improvement in risk prediction and reclassification (C-index change = 0.0178, NRI = 43.79%).
Conclusions:
- Elevated HGI during CPX is associated with a lower risk of SCD, indicating a potential dose-response relationship.
- While HGI enhances SCD risk prediction, CRF emerges as a more robust indicator and predictor of SCD.
- Both HGI and CRF provide valuable information for assessing SCD risk, with CRF showing a stronger independent association.
Introduction:
Haemodynamic gain index (HGI) is a novel haemodynamic parameter which can be obtained from cardiopulmonary exercise testing (CPX), but its association with sudden cardiac death (SCD) is not known. We aimed to assess the association of HGI with SCD risk in a long-term prospective cohort study.
Methods:
HGI was calculated using heart rate and systolic blood pressure (SBP) responses measured in 1897 men aged 42–61 years during CPX from rest to peak exercise. Cardiorespiratory fitness (CRF) was measured using respiratory gas exchange analysis. Multivariable adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) were estimated for SCD.
Results:
During a median follow-up of 28.7 years, 205 SCDs occurred. The risk of SCD decreased gradually with increasing HGI (p value for non-linearity = 0.63). A unit (bpm/mm Hg) higher HGI was associated with a decreased risk of SCD (HR: 0.84; 95% CI: 0.71-0.99), which was attenuated following adjustment for CRF. CRF was inversely associated with SCD, which remained after further adjustment for HGI (HR: 0.85; 95% CI: 0.77-0.94) per each unit higher CRF. Addition of HGI to a SCD risk prediction model containing established risk factors improved risk discrimination (C-index change = 0.0096; p = 0.017) and reclassification (net reclassification improvement [NRI] = 39.40%, p = 0.001). The corresponding values for CRF were (C-index change = 0.0178; p = 0.007) and (NRI = 43.79%, p = 0.001).
Conclusion:
Higher HGI during CPX is associated with a lower SCD risk, consistent with a dose-response relationship but dependent on CRF levels. Though HGI significantly improves the prediction and classification of SCD beyond common cardiovascular risk factors, CRF remains a stronger risk indicator and predictor of SCD compared to HGI.
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