BACKGROUND: Exercise right heart catheterization (RHC) unmasks different phenotypes based on hemodynamic response to exertion in patients with heart failure. The prognostic relevance of this approach in patients with heart failure and reduced ejection fraction (HFrEF) is uncertain. METHODS: We analyzed 167 patients with HFrEF from the Kerckhoff-Klinik Heart Failure Registry who underwent supine exercise RHC with constant external workload between September 2009 and August 2014. The primary outcome was heart transplant/assist device-free survival. Hemodynamic parameters that significantly predicted outcome were identified by multivariate Cox regression analysis and assessed further by Kaplan-Meier analysis after dichotomization using cutoffs derived from receiver operating characteristic analysis. Hemodynamic phenotypes were defined based on a dichotomized flow response (exercise-induced change in cardiac output [CO]) combined with a dichotomized pressure response (exercise-induced change in systolic [sPAP] or mean pulmonary arterial pressures). RESULTS: CO independently predicted transplant/assist device-free survival (multivariate hazard ratio [HR] 1.67; 95% confidence interval [CI], 1.09-2.58; p = 0.02). Patients with CO >/=1.15 liter/min had significantly better 5-year transplant/assist device-free survival than patients with lower CO (72.9% vs 22.5%; log-rank p < 0.001 [Kaplan-Meier analysis]). The hemodynamic phenotype of CO <1.15 liter/min combined with sPAP <17.5 mm Hg was associated with worse transplant/assist device-free survival than CO >/=1.15 liter/min combined with sPAP >/=17.5 mm Hg (multivariate HR 7.39; 95% CI, 2.27-24.05; p = 0.001). CONCLUSIONS: Exercise RHC parameters are important prognostic indices in HFrEF. Hemodynamic phenotyping using CO and sPAP allows enhanced risk stratification.
- Rieth, A.
- Richter, M. J.
- Gall, H.
- Seeger, W.
- Ghofrani, H. A.
- Mitrovic, V.
- Hamm, C. W.
Keywords
- exercise right heart catheterization
- heart failure with reduced ejection fraction
- hemodynamic phenotype
- prognostic factor
- survival