Highlights
- •Prognostic value of RV-CPO was tested in HF patients.
- •In contrast to LV-CPO and RV pulsatile load, RV-CPO did not determine CV outcome.
- •Combined echocardiographic LV-CPO and RV load could be a prognostic marker in HF.
Abstract
Background
Although left ventricular (LV) cardiac power output (CPO) is a powerful prognostic
indicator in heart failure (HF), the significance of right ventricular (RV) CPO is
unknown. In contrast, RV pulsatile load is a key prognostic marker in HF. We investigated
the impact of RV-CPO and pulsatile load on cardiac outcome and the prognostic performance
of the combined systemic and pulmonary circulation parameters in HF.
Methods
Right heart catheterization and echocardiography were performed in 231 HF patients
(62 ± 16 years, LV ejection fraction 42 ± 18 %). Invasive and noninvasive CPOs were
calculated from mean systemic or pulmonary arterial pressure and cardiac output. LV-CPO
was then normalized to LV mass (LV-P/M). Pulmonary arterial capacitance and the ratio
of acceleration time to ejection time (AcT/ET) of RV outflow were used as parameters
of RV pulsatile load. The primary endpoints, defined as a composite of cardiac death,
HF hospitalization, ventricular arrythmia, and LVAD implantation after the examination,
were recorded.
Results
Noninvasive CPOs were moderately correlated with invasive ones (LV: ρ = 0.787, RV:
ρ = 0.568, and p < 0.001 for both). During a median follow-up period of 441 days, 57 cardiovascular
events occurred. Lower LV-P/M and higher RV pulsatile load were associated with cardiovascular
events; however, RV-CPO was not associated with the outcome. Echocardiographic LV-P/M
and AcT/ET showed significant incremental prognostic value over the clinical parameters.
Conclusions
RV pulsatile load assessed by AcT/ET may be a predictor of clinical events in HF patients.
The combination of echocardiographic LV-P/M and AcT/ET could be a novel noninvasive
prognostic indicator in HF patients.
Graphical abstract
Graphical Abstract
Abbreviations:
RV (right ventricle), CPO (cardiac power output), LV (left ventricular), CV (cardiovascular), HF (heart failure)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cardiac pumping capability and prognosis in heart failure.Lancet. 1986; 2: 1360-1363
- Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry.J Am Coll Cardiol. 2004; 44: 340-348
- Prognostic role of cardiac power index in ambulatory patients with advanced heart failure.Eur J Heart Fail. 2015; 17: 689-696
- Prognostic value of peak stress cardiac power in patients with normal ejection fraction undergoing exercise stress echocardiography.Eur Heart J. 2021; 42: 776-785
- Peak cardiac power output, measured noninvasively, is a powerful predictor of outcome in chronic heart failure.Circ Heart Fail. 2009; 2: 33-38
- Peak power output to left ventricular mass: an index to predict ventricular pumping performance and morbidity in advanced heart failure.J Am Soc Echocardiogr. 2010; 23: 1259-1265
- Evaluation of resting cardiac power output as a prognostic factor in patients with advanced heart failure.Am J Cardiol. 2017; 120: 973-979
- Cardiac power output predicts mortality across a broad spectrum of patients with acute cardiac disease.Am Heart J. 2007; 153: 366-370
- Left ventricular heart failure and pulmonary hypertension.Eur Heart J. 2016; 37: 942-954
- Haemodynamic definitions and updated clinical classification of pulmonary hypertension.Eur Respir J. 2019; 53: 1801913
- Presence and relevance of midsystolic notching on right ventricular outflow tract flow velocity envelopes in pulmonary hypertension due to heart failure.J Am Soc Echocardiogr. 2021; 34e1
- Influence of advanced pulmonary vascular remodeling on accuracy of echocardiographic parameters of left ventricular filling pressure.Pulm Circ. 2021; 112045894020983723
- Determination of cardiac output by the Fick method, thermodilution, and acetylene rebreathing in pulmonary hypertension.Am J Respir Crit Care Med. 1999; 160: 535-541
- Prognostic role of pulmonary arterial capacitance in advanced heart failure.Circ Heart Fail. 2012; 5: 778-785
- Pulmonary artery pulsatility index: physiological basis and clinical application.Eur J Heart Fail. 2020; 22: 32-38
- Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients.Circulation. 2002; 106: I198-I202
- Right ventricular failure in idiopathic pulmonary arterial hypertension is associated with inefficient myocardial oxygen utilization.Circ Heart Fail. 2011; 4: 700-706
- 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: 1-39.e14
- Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.Am J Cardiol. 1986; 57: 450-458
- Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.J Am Soc Echocardiogr. 2010; 23: 685-713
- New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure.Chest. 2004; 126: 1313-1317
- Continuous-wave doppler echocardiographic detection of pulmonary regurgitation and its application to noninvasive estimation of pulmonary artery pressure.Circulation. 1986; 74: 484-492
- Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2016; 29: 277-314
- Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique.Circulation. 1983; 68: 302-309
- 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.J Am Coll Cardiol. 2013; 62: e147-e239
- Pulmonary hypertension in heart failure with preserved ejection fraction: a plea for proper phenotyping and further research.Eur Heart J. 2017; 38: 2869-2873
- Right heart dysfunction in heart failure with preserved ejection fraction.Eur Heart J. 2014; 35: 3452-3462
- The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates.J Am Coll Cardiol. 2008; 51: 2163-2172
- Pulmonary arterial capacitance is an important predictor of mortality in heart failure with a preserved ejection fraction.JACC Heart Fail. 2015; 3: 467-474
- Pulmonary arterial capacitance in patients with heart failure and reactive pulmonary hypertension.Eur J Heart Fail. 2015; 17: 74-80
- Different time course of changes in tricuspid regurgitant pressure gradient and pulmonary artery flow acceleration after pulmonary thromboendarterectomy: implications for discordant recovery of pulmonary artery pressure and compliance.Circ J. 2007; 71: 1771-1775
- Pulmonary capillary wedge pressure augments right ventricular pulsatile loading.Circulation. 2012; 125: 289-297
- Cardiac power output revisited.Circ Heart Fail. 2020; 13e007393
- Comparison of thermodilution and Fick methods for measurement of cardiac output in tricuspid regurgitation.Am J Cardiol. 1992; 70: 538-539
- Effect of the degree of tricuspid regurgitation on cardiac output measurements by thermodilution.Intensive Care Med. 2002; 28: 1117-1121
Article info
Publication history
Published online: December 16, 2022
Accepted:
November 20,
2022
Received in revised form:
October 21,
2022
Received:
August 3,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
