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Integrated Hemodynamic Measures of Cardiac Function and Association With Clinical Outcomes
Omar K Trad1, Juhi K Parekh2, Leah B Kosyakovsky3
1Harvard Medical School, Boston, Massachusetts, USA; CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
JACC. Advances
|May 15, 2026
Summary
Lower aortic pulsatility index (API) and cardiac power output (CPO) predict worse outcomes in cardiovascular patients. These key heart function metrics are valuable across a wide range of cardiovascular diseases, not just cardiogenic shock.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Outcomes Research
Background:
- Aortic pulsatility index (API) and cardiac power output (CPO) are established mortality predictors in cardiogenic shock.
- Their prognostic value across broader cardiovascular diseases remains under-explored.
Purpose of the Study:
- To investigate the association of API and CPO with clinical outcomes in a diverse hospital-based cardiovascular cohort.
- To determine if these hemodynamic parameters extend beyond cardiogenic shock for risk stratification.
Main Methods:
- Utilized a longitudinal, observational cohort of 4,278 patients undergoing right heart catheterization.
- Calculated API (aortic pulse pressure/pulmonary capillary wedge pressure) and CPO (cardiac output x mean arterial pressure/451).
- Employed multivariable Cox models to assess quartiles of API and CPO against mortality, MACE, and HFH.
Main Results:
- Lowest API quartile patients faced doubled mortality risk (HR: 2.06) and significantly higher risks for MACE (HR: 1.94) and HFH (HR: 2.82) versus the highest quartile.
- Lowest CPO quartile patients exhibited increased risks for death (HR: 1.25), MACE (HR: 1.51), and HFH (HR: 1.90) compared to the highest quartile.
- All associations were statistically significant (P < 0.001 for API, P < 0.005 for CPO).
Conclusions:
- Lower API and CPO are independently associated with adverse clinical outcomes in a broad cardiovascular population.
- These findings support the expanded clinical utility of API and CPO as prognostic markers across the spectrum of cardiovascular disease.
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