Prognostic value of resting cardiac power index depends on mean arterial pressure in dilated cardiomyopathy

Abstract

AimsIn recent decades, haemodynamic parameters have been estimated for risk stratification and determining treatment strategies for patients with non-ischaemic dilated cardiomyopathy (DCM). In various invasive procedures, the cardiac pumping capability is defined as cardiac power output (CPO), which is calculated by multiplying cardiac output by the mean arterial pressure. Lower CPO values in advanced heart failure predict adverse outcomes. However, few studies discuss the prognostic value of CPO in mild-to-moderate phase patients. This study aimed to determine the value of the cardiac power index (CPI) obtained from the resting CPO for predicting the prognosis of patients with New York Heart Association Functional Class II or III DCM. Methods and results From March 2000 to January 2020, a total of 623 cardiomyopathy patients were evaluated for haemodynamic parameters. Patients with secondary cardiomyopathy, ischaemic cardiomyopathy, valvular heart disease, and Class IV cardiomyopathy were excluded. A total of 176 DCM patients fulfilled the criteria for inclusion. Patients were 51.7 ± 12.5 years old (mean ± standard deviation) with a mean left ventricular ejection fraction of 32.1 ± 9.2%. The patients were divided into two groups by their median CPI (CPI < 0.52, low-CPI; CPI ≥ 0.52, high-CPI). No significant differences were found in the left ventricular end-diastolic diameter, left ventricular ejection fraction, or pulmonary arterial wedge pressure between the groups. The probability of cardiac event-free survival was significantly lower for low-CPI than for high-CPI groups by Kaplan-Meier analysis (P = 0.012), even with no significant difference between the high and low cardiac index groups (P = 0.069). Furthermore, Cox proportional hazards regression analysis revealed that, in addition to the CPI, the systolic and mean arterial pressure involved in CPI calculation were independent predictors of cardiac events. Indeed, among these factors, mean arterial pressure had the strongest prognostic ability. Conclusions Although CPI is effective for stratifying DCM and predicting cardiac events in patients with Class II/III DCM, this prognostic value depends on mean arterial pressure.

Programmatic approach to patients with advanced ischemic cardiomyopathy: Integrating microaxial support into strategies for the modern era

“…Despite a low LVEF, patients with a cardiac index (CI) >2.2 L/min/m 2 have a favorable probability of easily separating from cardiopulmonary bypass. Some centers also assess cardiac power output, calculated as mean arterial pressure times cardiac output, to further stratify patients based on this surrogate metric for cardiac pumping ability 33 . However, at our institution, we do not routinely factor cardiac power output into our therapeutic decision‐making process for advanced ICM patients.…”

Impact of invasively determined cardiac power index on survival in patients with advanced chronic heart failure

“…Yet, this prognostic value depends on the mean arterial pressure. 8 We evaluated patients with systolic heart failure. However, a recently published article by Harada et al investigated HF with preserved ejection fraction.…”

The cardiosplenic axis: the prognostic role of the spleen in heart failure

“…A lower resting cardiac power output has been demonstrated as a prognostic factor in patients with advanced disease after adjusting for certain variables, including age, sex, left ventricular ejection fraction (LVEF), and mean arterial pressure [ 13 ]. Moreover, a low cardiac power index has been shown to predict a high cardiac event rate in patients with NYHA functional class II/III heart failure [ 14 ]. Right heart catheterization (RHC) is also used to assess hemodynamics in patients with heart failure; however, owing to its invasive nature, RHC is associated with an increased risk of complications [ 15 ].…”