Integrated Hemodynamic Measures of Cardiac Function and Association With Clinical Outcomes

Aortic pulsatility index (API) and cardiac power output (CPO) are strongly associated with mortality in patients with cardiogenic shock, but their association with outcomes across broader cardiopulmonary disease is unknown.

The objective of the study was to examine the association of API and CPO with clinical outcomes across a hospital-based cardiovascular cohort.

We used a hospital-based longitudinal, observational cohort of patients who underwent right heart catheterization. We calculated API = aortic pulse pressure/pulmonary capillary wedge pressure and CPO = (cardiac output x mean arterial pressure)/451. We used multivariable Cox models to examine the association of API and CPO quartiles with all-cause mortality, major adverse cardiovascular events (MACE), and heart failure hospitalization (HFH).

A total of 4,278 patients (age 64 ± 11 years, 36.5% women, 35.3% prior heart failure) were included. Over a mean of 7 ± 3.2 years, there were 1,552 deaths, 1,429 MACE, and 991 HFH. Patients in the lowest API quartile had double the risk of death (HR: 2.06; 95% CI: 1.71-2.47), nearly double the risk of MACE (HR: 1.94; 95% CI: 1.65-2.30), and close to triple the risk of HFH (HR: 2.82; 95% CI: 2.31-3.45) compared to the highest quartile (all P < 0.001). Similarly, those in the lowest vs highest CPO quartile had greater risk of death (HR: 1.25; 95% CI: 1.08-1.46), MACE (HR: 1.51; 95% CI: 1.29-1.78), and HFH (HR: 1.90; 95% CI: 1.57-2.30; all P < 0.005).

Although lower API and CPO are known prognostic metrics in patients with cardiogenic shock, these findings support their broader utility across the spectrum of cardiovascular disease.