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Magnetic Adjustment of Afterload in Engineered Heart Tissues
Published on: May 5, 2020
Afterload-related cardiac performance is a powerful hemodynamic predictor of mortality in patients with chronic heart
Yihang Wu1, Pengchao Tian1, Lin Liang1
1Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Insights
Afterload-related cardiac performance (ACP) effectively predicts mortality in chronic heart failure (HF) patients. This hemodynamic parameter offers a novel approach to assessing cardiovascular function and guiding clinical decisions in HF management.
Area of Science:
- Cardiology
- Hemodynamics
- Heart Failure Research
Background:
- Afterload-related cardiac performance (ACP) is a diagnostic parameter for septic cardiomyopathy, integrating cardiac and vascular effects.
- ACP has shown potential in predicting prognosis in septic shock.
Purpose of the Study:
- To investigate the correlation between ACP and clinical outcomes in patients with chronic heart failure (HF).
- To establish a novel cardiac output-systemic vascular resistance (CO-SVR) curve model for chronic HF.
Main Methods:
- Retrospective study of consecutive chronic HF patients undergoing right heart catheterization.
- Development of an expected CO-SVR curve model specific to chronic HF.
- Calculation of ACP (COmeasured/COpredicted × 100%) and categorization of cardiovascular function impairment.
Main Results:
- The CO-SVR model (COpredicted = 53.468 × SVR⁻⁰·⁷⁹⁹) was established using 965 measurements from 290 patients.
- Severely impaired ACP (≤60%) correlated with higher NT-proBNP, lower LVEF, and increased dopamine use.
- Multivariate analysis confirmed ACP as an independent predictor of all-cause mortality (HR 0.956) and event-free survival (HR 0.977).
- ACP demonstrated superior discrimination for mortality prediction (AUC 0.770) compared to conventional hemodynamic parameters.
Conclusions:
- ACP is a potent independent hemodynamic predictor of mortality in chronic HF.
- The novel CO-SVR graph, alongside ACP, can aid in assessing cardiovascular function and informing clinical decisions for chronic HF patients.
Background:
Afterload-related cardiac performance (ACP), a diagnostic parameter for septic cardiomyopathy, integrates both cardiac performance and vascular effects and could predict prognosis in septic shock.
Objectives:
We hypothesized that ACP would also correlate with clinical outcomes in patients with chronic heart failure (HF).
Design:
A retrospective study.
Methods:
We retrospectively studied consecutive patients with chronic HF who underwent right heart catheterization and established an expected cardiac output-systemic vascular resistance (CO-SVR) curve model in chronic HF for the first time. ACP was calculated as COmeasured/COpredicted × 100%. ACP > 80%, 60% < ACP ⩽ 80%, and ACP ⩽ 60% represented less impaired, mildly impaired, and severely impaired cardiovascular function, respectively. The primary outcome was all-cause mortality, and the secondary outcome was event-free survival.
Results:
A total of 965 individual measurements from 290 eligible patients were used to establish the expected CO-SVR curve model (COpredicted = 53.468 × SVR -0.799). Patients with ACP ⩽ 60% had higher serum NT-proBNP levels (P < 0.001), lower left ventricular ejection fraction (P = 0.001), and required dopamine more frequently (P < 0.001). Complete follow-up data were available in 263 of 290 patients (90.7%). After multivariate adjustment, ACP remained associated with both primary outcome (hazard ratio (HR) 0.956, 95% confidence interval (CI) 0.927-0.987) and secondary outcome (HR 0.977, 95% CI 0.963-0.992). Patients with ACP ⩽ 60% had the worst prognosis (all P < 0.001). ACP was significantly more discriminating (area under the curve of 0.770) than other conventional hemodynamic parameters in predicting mortality (Delong test, all P < 0.05).
Conclusion:
ACP is a powerful independent hemodynamic predictor of mortality in patients with chronic HF. ACP and the novel CO-SVR two-dimensional graph could be useful in assessing cardiovascular function and making clinical decisions.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT02664818.
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