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Comparative Prognostic Value of Parameters of Pulsatile Right Ventricular Afterload in Patients With Advanced Heart Failure Awaiting Heart Transplantation

Published:September 12, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.08.010
      Right ventricular pulsatile afterload (RVPA) demonstrated a strong impact on survival of patients with advanced heart failure (HF) with reduced ejection fraction. The best prognostic parameter of RVPA is unknown. The aim of this work was to examine the prognostic relevance of pulmonary artery compliance (PAC), pulmonary artery elastance (PAE), and pulmonary artery pulsatile index (PAPi) in a consecutive cohort of patients with advanced HF evaluated for heart transplantation (HT).
      A total of 149 patients with end-stage HF underwent right-sided cardiac catheterization and were clinically followed up until death or any censoring events, including HT, left ventricular assist device, and hospitalization for acute HF. The primary endpoint occurred in 29 patients (19.5%) during a median follow-up time of 12 (interquartile range 3 to 34) months. This cohort presented a worse hemodynamic profile than event-free survivors. PAC <1.9 mL/mm Hg (hazard ratio 3, 95% confidence interval 1.3 to 6.0, p= 0.007) and PAE >0.9 mmHg/mL (hazard ratio 2.5, 95% confidence interval 1.1 to 5.2, p= 0.02) were associated with the adverse outcome. On the contrary, PAPi was not associated with the outcome. PAC demonstrated a superior predictive value for the composite adverse outcome compared with pulmonary vascular resistance (area under the curve comparison p= 0.019) and PAPi (p= 0.03) but similar compared with PAE (p= 0.19) and mean pulmonary arterial pressure (p= 0.51). PAC, but not PAE, showed incremental prognostic value compared with cardiac index (p= 0.02). In conclusion, hemodynamic indexes of RVPA are associated with worse survival in patients with end-stage HF. PAC and PAE demonstrated superior prognostic value compared with PAPi and pulmonary vascular resistance. Moreover, PAC showed incremental prognostic value compared with cardiac index in patients awaiting HT.

      Abbreviations:

      RVPA (Right ventricular pulsatile afterload), HF (Heart failure), HT (Heart transplantation)
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      References

        • Ghio S
        • Temporelli PL
        • Klersy C
        • Simioniuc A
        • Girardi B
        • Scelsi L
        • Rossi A
        • Cicoira M
        • Tarro Genta F
        • Dini FL
        Prognostic relevance of a non-invasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure.
        Eur J Heart Fail. 2013; 15: 408-414
        • Haddad F
        • Doyle R
        • Murphy DJ
        • Hunt SA.
        Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure.
        Circulation. 2008; 117: 1717-1731
        • Moraes DL
        • Colucci WS
        • Givertz MM.
        Secondary pulmonary hypertension in chronic heart failure: the role of the endothelium in pathophysiology and management.
        Circulation. 2000; 102: 1718-1723
        • Vachiéry JL
        • Adir Y
        • Barberà JA
        • Champion H
        • Coghlan JG
        • Cottin V
        • De Marco T
        • Galiè N
        • Ghio S
        • Gibbs JS
        • Martinez F
        • Semigran M
        • Simonneau G
        • Wells A
        • Seeger W.
        Pulmonary hypertension due to left heart diseases.
        J Am Coll Cardiol. 2013; 62: D100-D108
        • Aronson D
        • Eitan A
        • Dragu R
        • Burger AJ.
        Relationship between reactive pulmonary hypertension and mortality in patients with acute decompensated heart failure.
        Circ Heart Fail. 2011; 4: 644-650
        • Pellegrini P
        • Rossi A
        • Pasotti M
        • Raineri C
        • Cicoira M
        • Bonapace S
        • Dini FL
        • Temporelli PL
        • Vassanelli C
        • Vanderpool R
        • Naeije R
        • Ghio S.
        Prognostic relevance of pulmonary arterial compliance in patients with chronic heart failure.
        Chest. 2014; 145: 1064-1070
        • Dupont M
        • Mullens W
        • Skouri HN
        • Abrahams Z
        • Wu Y
        • Taylor DO
        • Starling RC
        • Tang WH.
        Prognostic role of pulmonary arterial capacitance in advanced heart failure.
        Circ Heart Fail. 2012; 5: 778-785
        • Tehrani BN
        • Truesdell AG
        • Sherwood MW
        • Desai S
        • Tran HA
        • Epps KC
        • Singh R
        • Psotka M
        • Shah P
        • Cooper LB
        • Rosner C
        • Raja A
        • Barnett SD
        • Saulino P
        • deFilippi CR
        • Gurbel PA
        • Murphy CE
        • O'Connor CM
        Standardized team-based care for cardiogenic shock.
        J Am Coll Cardiol. 2019; 73: 1659-1669
        • Morine KJ
        • Kiernan MS
        • Pham DT
        • Paruchuri V
        • Denofrio D
        • Kapur NK.
        Pulmonary artery pulsatility index is associated with right ventricular failure after left ventricular assist device surgery.
        J Card Fail. 2016; 22: 110-116
        • Gorter TM
        • van Veldhuisen DJ
        • Bauersachs J
        • Borlaug BA
        • Celutkiene J
        • Coats AJS
        • Crespo-Leiro MG
        • Guazzi M
        • Harjola VP
        • Heymans S
        • Hill L
        • Lainscak M
        • Lam CSP
        • Lund LH
        • Lyon AR
        • Mebazaa A
        • Mueller C
        • Paulus WJ
        • Pieske B
        • Piepoli MF
        • Ruschitzka F
        • Rutten FH
        • Seferovic PM
        • Solomon SD
        • Shah SJ
        • Triposkiadis F
        • Wachter R
        • Tschöpe C
        • de Boer RA.
        Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology.
        Eur J Heart Fail. 2018; 20: 16-37
        • Lang RM
        • Badano LP
        • Mor-Avi V
        • Afilalo J
        • Armstrong A
        • Ernande L
        • Flachskampf FA
        • Foster E
        • Goldstein SA
        • Kuznetsova T
        • Lancellotti P
        • Muraru D
        • Picard MH
        • Rietzschel ER
        • Rudski L
        • Spencer KT
        • Tsang W
        • Voigt JU.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
        • Scarsini R
        • Prioli MA
        • Milano EG
        • Castellani C
        • Pesarini G
        • Assael BM
        • Vassanelli C
        • Ribichini FL.
        Hemodynamic predictors of long term survival in end stage cystic fibrosis.
        Int J Cardiol. 2016; 202: 221-225
        • Kendrick AH
        • West J
        • Papouchado M
        • Rozkovec A.
        Direct Fick cardiac output: are assumed values of oxygen consumption acceptable?.
        Eur Heart J. 1988; 9: 337-342
        • Galiè N
        • Humbert M
        • Vachiery JL
        • Gibbs S
        • Lang I
        • Torbicki A
        • Simonneau G
        • Peacock A
        • Vonk Noordegraaf A
        • Beghetti M
        • Ghofrani A
        • Gomez Sanchez MA
        • Hansmann G
        • Klepetko W
        • Lancellotti P
        • Matucci M
        • McDonagh T
        • Pierard LA
        • Trindade PT
        • Zompatori M
        • Hoeper M
        • ESC Scientific Document Group
        2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
        Eur Heart J. 2016; 37: 67-119
        • Estep JD
        • Soltesz E
        • Cogswell R.
        The new heart transplant allocation system: early observations and mechanical circulatory support considerations.
        J Thorac Cardiovasc Surg. 2020; https://doi.org/10.1016/j.jtcvs.2020.08.113
        • Meyer P
        • Filippatos GS
        • Ahmed MI
        • Iskandrian AE
        • Bittner V
        • Perry GJ
        • White M
        • Aban IB
        • Mujib M
        • Dell'Italia LJ
        • Ahmed A
        Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure.
        Circulation. 2010; 121: 252-258
        • Carluccio E
        • Biagioli P
        • Alunni G
        • Murrone A
        • Zuchi C
        • Coiro S
        • Riccini C
        • Mengoni A
        • D'Antonio A
        • Ambrosio G
        Prognostic value of right ventricular dysfunction in heart failure with reduced ejection fraction: superiority of longitudinal strain over tricuspid annular plane systolic excursion.
        Circ Cardiovasc Imaging. 2018; 11e006894
        • Members: Authors/Task Force
        • TA McDonagh
        • Metra M
        • Adamo M
        • Gardner RS
        • Baumbach A
        • Böhm M
        • Burri H
        • Butler J
        • Čelutkienė J
        • Chioncel O
        • Cleland JGF
        • Coats AJS
        • Crespo-Leiro MG
        • Farmakis D
        • Gilard M
        • Heymans S
        • Hoes AW
        • Jaarsma T
        • Jankowska EA
        • Lainscak M
        • Lam CSP
        • Lyon AR
        • McMurray JJV
        • Mebazaa A
        • Mindham R
        • Muneretto C
        • Francesco Piepoli M
        • Price S
        • Rosano GMC
        • Ruschitzka F
        • Kathrine Skibelund A
        • Scientific Document Group ESC
        2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur J Heart Fail. 2022; 24: 4-131
        • Saouti N
        • Westerhof N
        • Helderman F
        • Marcus JT
        • Boonstra A
        • Postmus PE
        • Vonk-Noordegraaf A.
        Right ventricular oscillatory power is a constant fraction of total power irrespective of pulmonary artery pressure.
        Am J Respir Crit Care Med. 2010; 182: 1315-1320
        • Saouti N
        • Westerhof N
        • Postmus PE
        Vonk-Noordegraaf A. The arterial load in pulmonary hypertension.
        Eur Respir Rev. 2010; 19: 197-203
        • Thenappan T
        • Prins KW
        • Pritzker MR
        • Scandurra J
        • Volmers K
        • Weir EK.
        The critical role of pulmonary arterial compliance in pulmonary hypertension.
        Ann Am Thorac Soc. 2016; 13: 276-284
        • Wang Z
        • Chesler NC.
        Pulmonary vascular wall stiffness: an important contributor to the increased right ventricular afterload with pulmonary hypertension.
        Pulm Circ. 2011; 1: 212-223
        • Rajdev K
        • Lahan S
        • Wichman T.
        Role of pulmonary arterial capacitance in predicting mortality in patients with pulmonary hypertension: a systematic review and meta-analysis.
        Int J Cardiol. 2021; 333: 202-209
        • Lankhaar JW
        • Westerhof N
        • Faes TJ
        • Gan CT
        • Marques KM
        • Boonstra A
        • van den Berg FG
        • Postmus PE
        Vonk-Noordegraaf A. Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension.
        Eur Heart J. 2008; 29: 1688-1695
        • Tampakakis E
        • Shah SJ
        • Borlaug BA
        • Leary PJ
        • Patel HH
        • Miller WL
        • Kelemen BW
        • Houston BA
        • Kolb TM
        • Damico R
        • Mathai SC
        • Kasper EK
        • Hassoun PM
        • Kass DA
        • Tedford RJ.
        Pulmonary effective arterial elastance as a measure of right ventricular afterload and its prognostic value in pulmonary hypertension due to left heart disease.
        Circ Heart Fail. 2018; 11e004436
        • Crawford TC
        • Leary PJ
        • Fraser CD
        • Suarez-Pierre A
        • Magruder JT
        • Baumgartner WA
        • Zehr KJ
        • Whitman GJ
        • Masri SC
        • Sheikh F
        • De Marco T
        • Maron BA
        • Sharma K
        • Gilotra NA
        • Russell SD
        • Houston BA
        • Ramu B
        • Tedford RJ.
        Impact of the new pulmonary hypertension definition on heart transplant outcomes: expanding the hemodynamic risk profile.
        Chest. 2020; 157: 151-161
        • Milnor WR
        • Conti CR
        • Lewis KB
        • O'Rourke MF
        Pulmonary arterial pulse wave velocity and impedance in man.
        Circ Res. 1969; 25: 637-649
        • Wright SP
        • Groves L
        • Vishram-Nielsen JKK
        • Karvasarski E
        • Valle FH
        • Alba AC
        • Mak S.
        Elevated pulmonary arterial elastance and right ventricular uncoupling are associated with greater mortality in advanced heart failure.
        J Heart Lung Transplant. 2020; 39: 657-665
        • Lim HS
        • Gustafsson F.
        Pulmonary artery pulsatility index: physiological basis and clinical application.
        Eur J Heart Fail. 2020; 22: 32-38
        • Kochav SM
        • Flores RJ
        • Truby LK
        • Topkara VK.
        Prognostic impact of pulmonary artery pulsatility index (PAPi) in patients with advanced heart failure: insights from the ESCAPE trial.
        J Card Fail. 2018; 24: 453-459