Factors Associated with Progression to SCAI-Defined Hemodynamic Instability at 72 Hours in Patients with Acute...

Background: Early hemodynamic deterioration may occur in patients with acute decompensated heart failure (ADHF) receiving inotropic therapy despite the absence of overt hypoperfusion at baseline. This study aimed to identify baseline factors associated with progression from Society for Cardiovascular Angiography and Interventions (SCAI) stage A or B to SCAI stage C-E at 72 h after initiation of inotropic therapy. Methods: This retrospective, single-center study included 375 adults with ADHF who received intravenous dobutamine or levosimendan and were classified as SCAI stage A or B at the time of inotrope initiation. The primary endpoint was progression to SCAI stage C, D, or E at the 72 h assessment. Baseline clinical, echocardiographic, laboratory, and hemodynamic variables were compared according to progression status. Univariable and multivariable logistic regression analyses were performed to identify factors associated with the primary endpoint. Results: Progression to SCAI stage C-E occurred in 30 patients (8.0%). Patients who progressed had lower diastolic blood pressure (DBP) and higher heart rate, white blood cell count (WBC), C-reactive protein, aspartate aminotransferase, lactate dehydrogenase, and N-terminal pro-B-type natriuretic peptide levels. The primary multivariable logistic regression model included 327 patients and all 30 outcome events. Higher WBC was independently associated with greater odds of progression (odds ratio: 1.099; 95% confidence interval: 1.030-1.174; p = 0.005), whereas higher DBP was independently associated with lower odds of progression to SCAI stage C-E (odds ratio: 0.963; 95% confidence interval: 0.934-0.992; p = 0.014). The model showed acceptable calibration and moderate discrimination, with a c-statistic of 0.731 (95% confidence interval: 0.630-0.832). In bootstrap analysis, the association remained significant for WBC, whereas the association with DBP was borderline. Conclusions: Higher WBC and lower DBP were associated with progression to SCAI stage C-E at 72 h in this exploratory single-center cohort of patients with ADHF receiving inotropic therapy.