Comparative prognostic value of parameters of right ventricular pulsatile afterload in patients with advanced heart failure awaiting heart transplantation

Abstract Background Right ventricular (RV) function demonstrated a strong impact on survival of patients with advanced heart failure reduced ejection fraction (HFrEF). In particular, increased RV pulsatile afterload (RVPA) was associated poor prognosis. Several right catheterization-derived parameters have been proposed to characterize RVPA, including pulmonary artery compliance (PAC), elastance (PAE) and index (PAPi). However, among these indices, the best prognostic indicator is undetermined. Purpose To assess relevance RVPA in HFrEF evaluated for transplantation. Methods 149 end-stage underwent catheterization during evaluation All were clinically followed up until death or any censoring events transplantation, left assist device (LVAD) hospitalization acute failure. Cox regression ROC-curve analysis used test value determinants. Multivariate models C-statistics independent predictive indices. Results The mean age study population 56.6±10.1 years 85.2% male. most frequent aetiology ischemic cardiomyopathy (52.3%). Mean LV 25.7±10.2%. During follow time 17±15 months, 29 (19.5%) met primary endpoint: 9 (6%) died, 4 (2.68%) an urgent 11 (7.3%) LVAD implantation (as bridge transplantation therapy) 5 (3.3%) hospitalized HF. Patients who endpoint significantly older (61.2±7.8 vs 55.4±10.2, p=0.006) worse hemodynamic profile than event-free survivors (PAC [1.8±0.8 vs. 2.7±2.0, p=0.01], mPAP [33.5±11.3 29.3±11.0, p=0.05], PVR [3.0±1.6 2.6±2.0, p=0.09] PAE [1.12±0.5 0.98±0.6, p=0.04]). Among PAC<1.9 mL/mmHg (HR 4.0, CI 1.3–6.0, p=0.007) PAE>0.9 mmHg/mL 2.5, 95% 1.1–5.2, p=0.02) endpoint. On contrary, PAPi not outcome. PAC superior composite adverse outcome compared vascular resistances (PVR) (AUC comparison p=0.019) (p=0.03) but similar (p=0.19) (p=0.51). multivariable models, PAC, showed incremental cardiac (p=0.02). Conclusions Hemodynamic indices are steady-state PVR. Moreover, awaiting Funding Acknowledgement Type funding sources: None.