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Invasive Hemodynamic Predictors of Mortality in High-Output Heart Failure
Satoshi Miyashita1, Raquel Lamarche2, Rana Abualsaud3
1Department of Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine Heart, Vascular, and Thoracic Institute Cleveland Clinic Foundation, Cleveland, Ohio; Department of General Medicine, Juntendo University Faculty of Medicine, Japan.
Journal of Cardiac Failure
|November 13, 2025
Summary
High-output heart failure (HOHF) patients with elevated cardiac index (CI) face higher mortality risk. Hemodynamic assessment, particularly CI, is crucial for risk stratification and potential treatment improvements in HOHF.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- High-output heart failure (HOHF) is characterized by elevated cardiac output and volume overload.
- Limited data exist on the relationship between invasive hemodynamics and clinical outcomes in HOHF.
Purpose of the Study:
- To investigate the association between key invasive hemodynamic measures and all-cause mortality in patients with HOHF.
Main Methods:
- Retrospective analysis of 248 adult patients undergoing right heart catheterization with elevated cardiac index (CI) and filling pressures.
- Median follow-up of 3.3 years, with all-cause mortality as the primary endpoint.
- Multivariable analysis adjusted for demographics, comorbidities, and hemodynamic variables.
Main Results:
- Elevated cardiac index (CI) was the strongest predictor of mortality (HR 1.87, P < 0.001).
- Other mortality predictors included right atrial pressure (HR 1.30) and mean arterial pressure (HR 0.97).
- Systemic vascular resistance was inversely associated with mortality (HR 0.70).
Conclusions:
- Elevated CI is the most significant hemodynamic predictor of mortality in HOHF.
- Hemodynamic assessment aids in risk stratification for HOHF patients.
- Therapies targeting hemodynamics may improve outcomes in this population.
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