Andreas Rieth1, Manuel Jonas Richter2, Henning Gall3, Werner Seeger3, Hossein A Ghofrani2, Veselin Mitrovic4, Christian W Hamm5. 1. Department of Cardiology Kerckhoff-Klinik, Bad Nauheim, Germany. Electronic address: a.rieth@kerckhoff-klinik.de. 2. Department of Pneumology, Kerckhoff-Klinik, Bad Nauheim, Germany; Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, member of the German Center for Lung Research, Giessen, Germany. 3. Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, member of the German Center for Lung Research, Giessen, Germany. 4. Department of Cardiology Kerckhoff-Klinik, Bad Nauheim, Germany. 5. Department of Cardiology Kerckhoff-Klinik, Bad Nauheim, Germany; Department of Cardiology, Justus Liebig University Giessen, Universities of Giessen and Marburg, Giessen, Germany.
Abstract
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.
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.
Authors: Christoph B Wiedenroth Md; Andreas J Rieth Md; Steffen Kriechbaum Md; H-Ardeschir Ghofrani Md; Andreas Breithecker Md; Moritz Haas Md; Fritz Roller Md; Manuel J Richter Md; Mareike Lankeit; Lisa Mielzarek; Andreas Rolf Md; Christian W Hamm Md; Eckhard Mayer Md; Stefan Guth Md; Christoph Liebetrau Md Journal: Pulm Circ Date: 2020-08-18 Impact factor: 3.017
Authors: Andreas J Rieth; Manuel J Richter; Alexander Berkowitsch; Marc Frerix; Ingo H Tarner; Veselin Mitrovic; Christian W Hamm Journal: PLoS One Date: 2018-09-20 Impact factor: 3.240
Authors: Andreas J Rieth; Dimitri Grün; Georgios Zarogiannis; Steffen D Kriechbaum; Sebastian Wolter; Manuel J Richter; Khodr Tello; Ulrich Krüger; Veselin Mitrovic; Stephan Rosenkranz; Christian W Hamm; Till Keller Journal: Front Cardiovasc Med Date: 2022-03-31
Authors: Andreas J Rieth; Manuel J Richter; Khodr Tello; Henning Gall; Hossein A Ghofrani; Stefan Guth; Christoph B Wiedenroth; Werner Seeger; Steffen D Kriechbaum; Veselin Mitrovic; P Christian Schulze; Christian W Hamm Journal: Clin Res Cardiol Date: 2021-06-10 Impact factor: 5.460
Authors: Katarina Zeder; Chiara Banfi; Gregor Steinrisser-Allex; Bradley A Maron; Marc Humbert; Gregory D Lewis; Andrea Berghold; Horst Olschewski; Gabor Kovacs Journal: Eur Respir J Date: 2022-10-13 Impact factor: 33.795