Abstract 13563: Long-Term Prognostic Value of Afterload Mismatch Index in Acute Decompensated Heart Failure With and Without Reduced Left Ventricular Ejection Fraction

Backgrounds: Ventricular-arterial coupling has been shown to have physiologic importance in heart failure. At the acute worsening of heart failure, increased ratio of pulmonary capillary wedge pressure to systemic systolic pressure (PCWP/SBP) might reflect the degree of afterload mismatch. However, there is no information available on the long-term prognostic value of PCWP/SBP in patients with acute decompensated heart failure (ADHF), relating to reduced left ventricular ejection fraction (LVEF).

Methods: We studied 240 patients admitted for ADHF (with LVEF<40% [HFrEF, n=110] and without LVEF<40% [n=130]), who underwent right heart catheterization at the admission and were discharged with survival. PCWP/SBP was obtained at the admission. The study endpoint was cardiovascular death (CVD).

Results: During a mean follow-up period of 5.2±4.4 yrs, 59 patients had CVD. PCWP/SBP was significantly higher in patients with than without CVD (0.216±0.078 vs 0.172±0.064, p<0.0001). Multivariate Cox regression analysis revealed that PCWP/SBP was significantly associated with CVD, independently of prior heart failure hospitalization, body mass index, estimated glomerular filtration rate, and serum sodium level. Patients with high PCWP/SBP (>0.206 determined by ROC analysis: AUC 0.668[0.586-0.749]) had a significantly greater CVD risk than those with low PCWP/SBP (≤0.206) in both groups with and without HFrEF(with: 36% vs 11%, p=0.016; without: 42% vs 18%, p=0.0057).

Conclusions: PCWP/SBP, an index of afterload mismatch, could provide the long-term prognostic information in patients admitted with ADHF, regardless of reduced LVEF.