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Ngan C, Zeng X, Lia T, Yin W, Kang Y. Cardiac index and heart rate as prognostic indicators for mortality in septic shock: A retrospective cohort study from the MIMIC-IV database. Heliyon 2024; 10:e28956. [PMID: 38655320 PMCID: PMC11035949 DOI: 10.1016/j.heliyon.2024.e28956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/15/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Background Septic shock is a life-threatening condition that can lead to organ dysfunction and death. In the ICU, monitoring of cardiac index (CI) and heart rate (HR) is commonly used to guide management and predict outcomes in septic shock patients. However, there is a lack of research on the association between CI and HR and the risk of mortality in this patient population. Therefore, the aim of this study was to investigate the relationship between different levels of CI and HR and mortality in septic shock patients. Methods Data analysis was obtained from the MIMIC-IV version 2.0 database. Sepsis and septic shock were primarily defined by sepsis-3, the third international consensus on sepsis and septic shock. CI was computed using cardiac output (CO) and body surface area (BSA). To evaluate the incidence of CI with respect to each endpoint (7-, 14-, 21-, and 28-day mortality), a restricted cubic spline curve function (RCS) was used. The optimal cutoff value for predicted mortality was determined using the Youden index. Analyses of KM curves, cox regression, and logistic regression were conducted separately to determine the relationship between various CI and HR and 28-day mortality. Results This study included 1498 patients with septic shock. A U-shaped relationship between CI levels and risk of mortality in septic shock was found by RCS analysis (p < 0.001). CI levels within the intermediate range of 1.85-2.8 L/min/m2 were associated with a mortality hazard ratio (HR) < 1. In contrast, low CI (HR = 1.87 95% CI: 1.01-3.49) and high CI (HR = 1.93 95% CI: 1.26-2.97) had a significantly increased risk of mortality. The AUC for heart rate prediction of mortality by Youden index analysis was 0.70 95%CI:0.64-0.76 with a cut-off value of 93.63 bpm. According to the characteristics of HR and CI, patients were divided into six subgroups HR↓+CI intermediate group (n = 772), HR↓+CI↓ group (n = 126), HR↓+CI↑ group (n = 294), HR↑+CI intermediate group (n = 132), HR↑+CI↓ group (n = 24), and HR↑+CI↑ group (n = 150). The KM curves, COX regression, and logistic regression analysis showed that the survival rates the of HR↓+CI intermediate group, HR↓+CI↓ group, and HR↓+CI↑ were higher than the other groups. The risk factors of HR↑+CI intermediate group, HR↑+CI↓, and HR↑+CI↑ with ICU 28-day mortality were HR = 2.91 (95% CI: 1.39-5.97), HR = 3.67 (95% CI: 1.39-11.63), and HR = 5.77 (95% CI: 2.98-11.28), respectively. Conclusion Our retrospective study shows that monitoring cardiac index and heart rate in patients with septic shock may help predict the organismal response and hemodynamic consequences, as well as the prognosis. Thus, healthcare providers should carefully monitor changes in these parameters in septic shock patients transferred to the ICU for treatment.
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Affiliation(s)
- Chansokhon Ngan
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xueying Zeng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Thongher Lia
- Department of Urology Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Jose A, Rahman N, Opotowsky AR, Glorioso TJ, Waldo SW, Zeder K, Seto A, Elwing JM, McCormack FX, Maron BA. Association of Cardiopulmonary Hemodynamics and Mortality in Veterans With Liver Cirrhosis: A Retrospective Cohort Study. J Am Heart Assoc 2024; 13:e033847. [PMID: 38567662 PMCID: PMC11262483 DOI: 10.1161/jaha.123.033847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Portopulmonary hypertension (PoPH), associated with increased mortality, can limit treatment options for liver diseases. Data on the continuum of clinical risk related to cardiopulmonary hemodynamics in PoPH are lacking. METHODS AND RESULTS As part of the United States national Veterans Affairs Clinical Assessment, Reporting, and Tracking database, we performed a retrospective cohort study of adults with cirrhosis undergoing right heart catheterization between October 1, 2017, and September 30, 2022. Pulmonary hypertension (mean pulmonary arterial pressure [mPAP] >20 mm Hg without PoPH) and PoPH (mPAP >20 mm Hg+pulmonary artery wedge pressure ≤15 mm Hg+pulmonary vascular resistance ≥3 WU) were defined by right heart catheterization hemodynamics. Multivariable Cox proportional hazards using natural splines for hemodynamic variables were used to evaluate the association between cardiopulmonary hemodynamics and mortality following right heart catheterization. A total of 4409 patients were included in the final analysis, predominantly men (96.3%), with a mean age of 68.5 years. Pulmonary hypertension and PoPH were observed in 71.6% and 10.2% of the cohort, respectively. Compared with a reference cardiac index of 2.5 L/min per m2, the hazard for mortality increased progressively with decreasing cardiac index, even after adjustment for mPAP and pulmonary vascular resistance. The minority of patients with PoPH (N=65, 14.5%) were prescribed pulmonary vasodilator therapy. CONCLUSIONS These data suggest that pulmonary hypertension and PoPH are prevalent in veterans with chronic liver disease, but low use of targeted PoPH therapy persists. Cardiac function discriminated mortality risk across a wide range of mPAP and pulmonary vascular resistance values and may diagnose and clarify prognosis in this patient population.
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Affiliation(s)
- Arun Jose
- Veterans Affairs Cincinnati Healthcare SystemCincinnatiOH
- University of CincinnatiOH
| | - Natalia Rahman
- Rocky Mountain Regional VA Medical CenterAuroraCO
- Denver Research InstituteAuroraCO
| | - Alexander R. Opotowsky
- Heart Institute, Cincinnati Children’s Hospital Medical Center, University of CincinnatiOH
| | - Thomas J. Glorioso
- CART Program, Office of Quality and Patient Safety, Veterans Health AdministrationWashingtonDC
| | - Stephen W. Waldo
- Rocky Mountain Regional VA Medical CenterAuroraCO
- CART Program, Office of Quality and Patient Safety, Veterans Health AdministrationWashingtonDC
- University of Colorado School of MedicineAuroraCO
| | - Katarina Zeder
- Brigham and Women’s Hospital and Harvard Medical SchoolBostonMA
- Department of MedicineUniversity of Maryland School of MedicineBaltimoreMD
- The University of Maryland‐Institute for Health ComputingBethesdaMD
- Ludwig Boltzmann Institute for Lung Vascular Research, Medical University of GrazAustria
| | - Arnold Seto
- Veteran’s Affairs Long Beach Healthcare SystemLong BeachCA
| | | | - Francis X. McCormack
- Veterans Affairs Cincinnati Healthcare SystemCincinnatiOH
- University of CincinnatiOH
| | - Bradley A. Maron
- Veterans Affairs Boston Healthcare SystemBostonMA
- Brigham and Women’s Hospital and Harvard Medical SchoolBostonMA
- Department of MedicineUniversity of Maryland School of MedicineBaltimoreMD
- The University of Maryland‐Institute for Health ComputingBethesdaMD
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3
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Ngan C, Zeng X, Lia T, Yin W, Kang Y. Cardiac index and heart rate as prognostic indicators for mortality in septic shock: A retrospective cohort study from the MIMIC-IV database. Heliyon 2024; 10:e28956. [DOI: https:/doi.org/10.1016/j.heliyon.2024.e28956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
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4
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Widmann L, Keranov S, Jafari L, Liebetrau C, Keller T, Troidl C, Kriechbaum S, Voss S, Arsalan M, Richter MJ, Tello K, Gall H, Ghofrani HA, Guth S, Seeger W, Hamm CW, Dörr O, Nef H. Fibroblast growth factor 23 as a biomarker of right ventricular dysfunction in pulmonary hypertension. Clin Res Cardiol 2023; 112:1382-1393. [PMID: 36790465 PMCID: PMC10562503 DOI: 10.1007/s00392-023-02162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 01/19/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Fibroblast growth factor 23 (FGF-23) has been associated with left ventricular hypertrophy (LVH) and heart failure. However, its role in right ventricular (RV) remodeling and RV failure is unknown. This study analyzed the utility of FGF-23 as a biomarker of RV function in patients with pulmonary hypertension (PH). METHODS In this observational study, FGF-23 was measured in the plasma of patients with PH (n = 627), dilated cardiomyopathy (DCM, n = 59), or LVH with severe aortic stenosis (n = 35). Participants without LV or RV abnormalities served as controls (n = 36). RESULTS Median FGF-23 plasma levels were higher in PH patients than in healthy controls (p < 0.001). There were no significant differences between PH, DCM, and LVH patients. Analysis across tertiles of FGF-23 levels in PH patients revealed an association between higher FGF-23 levels and higher levels of NT-proBNP and worse renal function. Furthermore, patients in the high-FGF-23 tertile had a higher pulmonary vascular resistance (PVR), mean pulmonary artery pressure, and right atrial pressure and a lower cardiac index (CI) than patients in the low tertile (p < 0.001 for all comparisons). Higher FGF-23 levels were associated with higher RV end-diastolic diameter and lower tricuspid annular plane systolic excursions (TAPSE) and TAPSE/PASP. Receiver operating characteristic analysis revealed FGF-23 as a good predictor of RV maladaptation, defined as TAPSE < 17 mm and CI < 2.5 L/min/m2. Association of FGF-23 with parameters of RV function was independent of the glomerular filtration rate in regression analysis. CONCLUSION FGF-23 may serve as a biomarker for maladaptive RV remodeling in patients with PH.
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Affiliation(s)
- Laila Widmann
- Department of Cardiology and Angiology, University of Giessen, Klinikstr. 33, 35392, Giessen, Germany
| | - Stanislav Keranov
- Department of Cardiology and Angiology, University of Giessen, Klinikstr. 33, 35392, Giessen, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Bad Nauheim, Germany.
| | - Leili Jafari
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | | | - Till Keller
- Department of Cardiology and Angiology, University of Giessen, Klinikstr. 33, 35392, Giessen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Bad Nauheim, Germany
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Christian Troidl
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Bad Nauheim, Germany
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Steffen Kriechbaum
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Bad Nauheim, Germany
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Sandra Voss
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Bad Nauheim, Germany
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Mani Arsalan
- Department of Cardiology and Angiology, University of Giessen, Klinikstr. 33, 35392, Giessen, Germany
| | - Manuel J Richter
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Khodr Tello
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Hossein A Ghofrani
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Werner Seeger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, University of Giessen, Klinikstr. 33, 35392, Giessen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Bad Nauheim, Germany
- Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Oliver Dörr
- Department of Cardiology and Angiology, University of Giessen, Klinikstr. 33, 35392, Giessen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Bad Nauheim, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, University of Giessen, Klinikstr. 33, 35392, Giessen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Bad Nauheim, Germany
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Ngan C, Li L, Wang M, Zeng X, Yin W, Kang Y. The Impact of Cardiac Index on Mortality in Patients with Septic Shock: A retrospective study from the MIMIC-IV Database.. [DOI: 10.21203/rs.3.rs-2896191/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
Abstract
Background
Septic shock is a life-threatening condition that can lead to organ dysfunction and death. In the ICU, monitoring of cardiac index (CI) is commonly used to guide management and predict outcomes in septic shock patients. However, there is a lack of research on the association between CI and the risk of mortality in this patient population. Therefore, the aim of this study was to investigate the relationship between different levels of CI and mortality in septic shock patients.
Methods
Data analysis was obtained from the MIMIC-IV version 2.0 database. Sepsis and septic shock were primarily defined by sepsis-3, the third international consensus on sepsis and septic shock. CI was computed using cardiac output (CO) and body surface area (BSA). To evaluate the incidence of CI with respect to each endpoint (7-, 14-, 21-, and 28-day mortality), a restricted cubic spline curve function (RCS) was used. Analyses of KM curves, cox regression, and logistic regression were conducted separately to determine the relationship between various CI and 28-day mortality.
Results
This study included 1498 patients with septic shock. A U-shaped relationship between CI levels and risk of mortality in septic shock was found by RCS analysis (p < 0.001). CI levels in the range of 1.85–2.8 L/min/m2 were associated with a mortality hazard ratio (HR) < 1. In contrast, low CI and high CI levels had a significantly increased risk of mortality. According to the characteristics of CI, patients were divided into three groups low CI group (CI < 1.85 L/min/m2,n = 150), CI normal group (CI:1.85–2.80 L/min/m2, n = 904), and the high group(CI > 2.80 L/min/m2,n = 444). The KM curves, COX regression, and logistic regression analysis showed that the survival rate the of CI normal group was higher than the other groups. The risk factors of the low CI group, and high CI with ICU 28-day mortality were HR = 1.87 (95% CI: 1.01–3.49), and HR = 1.93 (95% CI: 1.26–2.97), respectively.
Conclusion
This study found that a cardiac index (CI) of 1.85–2.80 L/min/m2 was associated with the lowest risk of mortality in patients with septic shock. CIs that were lower or higher than this range were associated with an increased risk of mortality.
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Hiraiwa H, Sakamoto G, Ito R, Koyama Y, Kazama S, Kimura Y, Kondo T, Morimoto R, Okumura T, Murohara T. Dynamic chest radiography as a novel minimally invasive hemodynamic imaging method in patients with heart failure. Eur J Radiol 2023; 161:110729. [PMID: 36804311 DOI: 10.1016/j.ejrad.2023.110729] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Dynamic chest radiography allows for non-invasive cardiopulmonary blood flow assessment. However, data on its use for heart failure hemodynamic assessment are scarce. We utilized dynamic chest radiography to estimate heart failure hemodynamics. METHOD Twenty heart failure patients (median age, 67 years; 17 men) underwent dynamic chest radiography and right heart catheterization. The analyzed images were 16-bit images (grayscale range: 0-65,535). Right atrial, right pulmonary artery, and left ventricular apex pixel values (average of the grayscale values of all pixels within a region of interest) were measured. The correlations of the minimum, maximum, mean, amount of change, and rate of change in pixel values with right atrial pressure, pulmonary artery pressure, pulmonary artery wedge pressure, and cardiac index were analyzed. RESULTS The mean right atrial pixel value and mean right atrial pressure (R = -0.576, P = 0.008), mean right pulmonary artery pixel value and mean pulmonary artery pressure (R = -0.546, P = 0.013), and left ventricular apex pixel value change rate and mean pulmonary artery wedge pressure (R = -0.664, P = 0.001) or cardiac index (R = 0.606, P = 0.005) were correlated. The left ventricular apex pixel value change rate identified low cardiac index (area under the curve, 0.792; 95% confidence interval, 0.590-0.993; P = 0.031) and low cardiac index with high pulmonary artery wedge pressure (area under the curve, 0.902; 95% confidence interval, 0.000-1.000; P = 0.030). CONCLUSIONS Dynamic chest radiography is a minimally invasive tool for heart failure hemodynamic assessment.
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Affiliation(s)
- Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Gaku Sakamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Ryota Ito
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yuichiro Koyama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Shingo Kazama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yuki Kimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Parmana IMA, Boom CE, Rachmadi L, Hanafy DA, Widyastuti Y, Mansyur M, Siswanto BB. Correlation Between Cardiac Index, Plasma Troponin I, Myocardial Histopathology, CPB and AoX Duration in Glutamine versus No Glutamine Administered Patients with Low Ejection Fraction Undergoing Elective On-Pump CABG Surgery: Secondary Analysis of an RCT. Vasc Health Risk Manag 2023; 19:93-101. [PMID: 36880009 PMCID: PMC9985398 DOI: 10.2147/vhrm.s399925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/18/2023] [Indexed: 03/04/2023] Open
Abstract
Purpose On-pump coronary artery bypass graft (CABG) causes myocardial ischemia, through the cardiopulmonary bypass (CPB) and aortic cross-clamping (AoX). Glutamine supplementation protects cardiac cells during cardiac ischemia. This study analysed the correlation between cardiac index (CI), plasma troponin I, myocardial histopathology, CPB and AoX duration in low ejection fraction patients receiving glutamine and no glutamine undergoing elective on-pump CABG. Material and Methods This was a secondary analysis of a double-blind, randomised controlled trial of 60 patients, split into control and intervention (glutamine) groups. Glutamine was administered at a dose of 0.5 g/kg/24 hours. There were 29 patients in each respective groups after a total of two patients dropped out. Results A negative correlation (p = 0.037) was observed between CPB duration and CI at 6 hours after CPB in the glutamine group. A positive correlation (p = 0.002) was also observed between AoX duration and plasma troponin I at 6 hours after CPB in the control group. However, no correlation was observed between myocardial histopathology and plasma troponin I level at 5 minutes after CPB. Conclusion Significant negative correlation between CPB duration and CI at 6 hours after CPB in the glutamine group, along with significant positive correlation between AoX duration and plasma troponin I level at 6 hours after CPB in the control group demonstrated the myocardial protection qualities of intravenous glutamine administration in patients with low ejection fraction undergoing elective on-pump CABG surgeries.
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Affiliation(s)
- I Made Adi Parmana
- Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Cindy Elfira Boom
- Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Lisnawati Rachmadi
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dudy Arman Hanafy
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yunita Widyastuti
- Department of Anesthesiology and Intensive Care, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Baudry G, Bourdin J, Mocan R, Hugon-Vallet E, Pozzi M, Jobbé-Duval A, Paulo N, Rossignol P, Sebbag L, Girerd N. Prognosis of Advanced Heart Failure Patients according to Their Hemodynamic Profile Based on the Modified Forrester Classification. J Clin Med 2022; 11:jcm11133663. [PMID: 35806946 PMCID: PMC9267518 DOI: 10.3390/jcm11133663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction: Heart transplantation (HT) remains the gold-standard treatment but is conditioned by organ shortage. This study aimed to evaluate the value of Forrester classification and determine which congestion criteria had the best prognostic value to predict cardiorenal events on heart transplant waiting list. Methods and results: One hundred consecutive patients (54 years old, 72% men) with available right heart catheterization (RHC) listed in our center for HT between 2014 and 2019 were included. Cardiac catheterization measurements were obtained at the time of HT listing evaluation. Patients were classified according to perfusion and congestion status in four groups: “warm and dry”, “warm and wet”, “cold and dry”, and “cold and wet”. pWet was used to classify patients with pulmonary congestion and sWet for systemic congestion. The primary endpoint was the rate of a composite criteria of cardiogenic shock, acute kidney injury, and acute heart failure. Secondary endpoint was the incidence of waitlist death, emergency HT, or left ventricular assist device (LVAD) implantation at 12 months evaluated by Kaplan–Meier curves and log-rank test. Only Forrester classification according to systemic congestion was associated with the primary composite endpoint (p = 0.011), while patients’ profile according to pulmonary congestion was not (p = 0.331). Similarly, only the Forrester classification according to systemic congestion predicted waitlist death, emergency HT, or LVAD implantation at 12 months, with p = 0.010 and p = 0.189 for systemic and pulmonary congestion, respectively. Moreover, systemic congestion was the main driver of cardiorenal events on waitlist. Conclusions: Forrester classification according to systemic congestion is associated with cardiorenal outcomes in patients listed for heart transplant and the risk of waitlist death, emergency HT, or LVAD implantation at 12 months.
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Affiliation(s)
- Guillaume Baudry
- Service d’insuffisance Cardiaque, Hôpital Cardiovasculaire Louis Pradel, 69500 Bron, France; (J.B.); (R.M.); (E.H.-V.); (A.J.-D.); (N.P.); (L.S.)
- Centre d’Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France; (P.R.); (N.G.)
- Correspondence:
| | - Juliette Bourdin
- Service d’insuffisance Cardiaque, Hôpital Cardiovasculaire Louis Pradel, 69500 Bron, France; (J.B.); (R.M.); (E.H.-V.); (A.J.-D.); (N.P.); (L.S.)
| | - Raluca Mocan
- Service d’insuffisance Cardiaque, Hôpital Cardiovasculaire Louis Pradel, 69500 Bron, France; (J.B.); (R.M.); (E.H.-V.); (A.J.-D.); (N.P.); (L.S.)
| | - Elisabeth Hugon-Vallet
- Service d’insuffisance Cardiaque, Hôpital Cardiovasculaire Louis Pradel, 69500 Bron, France; (J.B.); (R.M.); (E.H.-V.); (A.J.-D.); (N.P.); (L.S.)
| | - Matteo Pozzi
- Service de Chirurgie Cardiaque, Hôpital Cardiovasculaire Louis Pradel, 69500 Bron, France;
| | - Antoine Jobbé-Duval
- Service d’insuffisance Cardiaque, Hôpital Cardiovasculaire Louis Pradel, 69500 Bron, France; (J.B.); (R.M.); (E.H.-V.); (A.J.-D.); (N.P.); (L.S.)
| | - Nicolas Paulo
- Service d’insuffisance Cardiaque, Hôpital Cardiovasculaire Louis Pradel, 69500 Bron, France; (J.B.); (R.M.); (E.H.-V.); (A.J.-D.); (N.P.); (L.S.)
| | - Patrick Rossignol
- Centre d’Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France; (P.R.); (N.G.)
| | - Laurent Sebbag
- Service d’insuffisance Cardiaque, Hôpital Cardiovasculaire Louis Pradel, 69500 Bron, France; (J.B.); (R.M.); (E.H.-V.); (A.J.-D.); (N.P.); (L.S.)
| | - Nicolas Girerd
- Centre d’Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France; (P.R.); (N.G.)
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