SPC365

Hemodynamic gain index: a new prognostic marker in heart failure?

Session: Posters (Sessão 2 - Écran 4) - Insuficiência Cardíaca 2 - Índices e Factores de Prognóstico
Speaker: João Borges Rosa

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: João Borges Rosa; José Lopes de Almeida; Sofia s. Martinho; Joana Guimarães; Diogo de Almeida Fernandes; Eric Alberto Monteiro; Gonçalo Ferraz Costa; Gustavo m. Campos; Ana Rita m. Gomes; James Milner; Manuel Oliveira-Santos; Lino Gonçalves

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">Introduction:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">&nbsp;Cardiopulmonary exercise testing (CPET) is recommended in patients with heart failure (HF) to optimize exercise&nbsp;prescription&nbsp;and as part of the evaluation for heart transplantation. Hemodynamic gain index (HGI) derived from CPET has been proposed as a new marker of risk stratification in general population cohorts. We aimed to evaluate the prognostic value of HGI in patients with HF.&nbsp;&nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">Methods:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">&nbsp;We conducted a single-centre study assessing consecutive patients with HF who underwent CPET from 2013 to 2017. HGI was calculated based on heart rate (HR) and systolic blood pressure (SBP): HGI=[(HRpeak x SBPpeak) - (HRrest x SBPrest)]/(HRrest x SBPrest). Classic and recently proposed variables were collected, including peak O2 uptake (pVO2), minute ventilation&ndash;CO2 production (VE/VCO2 slope), circulatory power (CP=pVO2 x peak SBP), and ventilatory power (VP=peak SBP/(VE/VCO2) slope). The primary outcome was a composite of HF hospitalization, heart transplant, and all-cause mortality.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">Results:&nbsp;&nbsp;</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">A total of 212 patients (mean age 55.4&plusmn;10.9, 76.9% male) were included. Most patients had dilated cardiomyopathy (43.9%)&nbsp;followed by ischaemic aetiology (38.7%), with a mean left ventricle ejection fraction of 29&plusmn;13%. The most used exercise protocol was&nbsp;the modified Naughton (76.6%), followed by&nbsp;the original Naughton (18.7%), and Bruce (4.8%). Mean pVO2 was 16.7&plusmn;5.9mL O2&middot;kg<sup>&minus;1</sup>&middot;min<sup>&minus;1</sup>&nbsp;and median VE/VCO2 slope was 37.5 [32.7-44.3]. Mean VP was 3.46&plusmn;1.31mmHg&nbsp;while median CP&nbsp;was 1927 [1427-2697]mmHg&middot;min/mL/kg. Mean HGI was 0.90&plusmn;0.5 bpm/mmHg.&nbsp;Despite weak, there were significant positive correlations between HGI and mean pVO2 (r<sub>s</sub>=0.55, p&lt;0.01),&nbsp;VP (r=0.60, p&lt;0.01),&nbsp;and CP (r<sub>s</sub>=0.68, p&lt;0.01), but negative correlation between HGI and VE/VCO2 slope (r<sub>s</sub>= -0.45, p&lt;0.01). HGI was grouped by terciles: </span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">T1 (&lt;0.59), T2 (0.59-1.02), and T3 (&gt;1.02)<span style="color:#222222">. After a median follow-up of 71 [49-81] months, the primary outcome occurred in 66.0% of patients (rehospitalization, heart transplant, and all-cause death occurred in 56.1%, 25.9%, and 32.5%, respectively). In the T1 group, the multivariable-adjusted odds ratio (OR) for the primary outcome was 3.73 (95% CI 1.97-7.06, p&lt;0.01) compared to the T3. In the T2 group, the multivariable-adjusted OR for the primary outcome was 0.47 (95% CI 0.27-0.81, p&lt;0.01) compared to T1. There were no significant differences between T2 and T3 groups. Kaplan-Meier estimates of primary outcome during follow-up according to HGI terciles are shown in Figure 1.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">Conclusion:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">&nbsp;HGI is inversely associated with the composite of HF hospitalization, heart transplant, and all-cause mortality in patients with heart failure, enhancing the role of CPET in risk stratification.&nbsp;&nbsp;</span></span></span></span></span></p>