The following is a summary of “PREDICT HF: Risk stratification in advanced heart failure using novel hemodynamic parameters,” published in the June 2024 issue of Cardiology by Cyrille-Superville et al.

Invasive hemodynamics are crucial for evaluating patients with severe heart failure (HF). Many new parameters have been explored, but the prognostic value isn’t clearly defined.

Researchers conducted a retrospective study assessing if advanced hemodynamic parameters offer better prognosis prediction than standard assessments. 

They analyzed patients from the PRognostic Evaluation During Invasive CaTheterization for Heart Failure (PREDICT-HF) registry who had right heart catheterization (RHC). The main goal was to see if the patients survived long enough for an orthotopic heart transplant (OHT) or durable left ventricular assist device (LVAD) or if patients died within 6 months of RHC.

The results showed 846 patients selected, 176 (21%) had adverse outcomes. Traditional variables like pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) predicted adverse outcomes (for PCWP, [OR: 1.10, 1.04-1.15, P<0.001], for CI, [OR: 0.86, 0.81-0.92, P<0.001]). Advance parameters were associated with the primary outcome, cardiac power output (CPO) (OR: 0.76, 0.71-0.83, P<0.001) and aortic pulsatility index (API) (OR: 0.94, 0.91-0.96, P<0.001), and pulmonary artery pulsatility index (OR: 1.02, 1.00-1.03, P<0.027). Positively concordant API and CPO showed the best freedom from the endpoint (94.7%), whereas negatively concordant API and CPO had the worst freedom (61.5%, P<0.001). Meanwhile, discordant API and CPO had similar freedom from the endpoint. 

Investigators concluded that advanced hemodynamic parameters like API and CPO predicted death or the need for a heart transplant or LVAD within 6 months. More studies needed to confirm the usefulness in severe patients with HF.

Source: onlinelibrary.wiley.com/doi/full/10.1002/clc.24277