Abstract 16345: Arterial Wave Reflection is the Most Important Pulsatile Hemodynamic Prognostic Indicator in Acute Heart Failure Syndrome
Background The importance of arterial wave reflections in the pathogenesis of heart failure may have been underestimated. The present study investigated the differential prognostic roles of wave reflections and arterial stiffness in patients hospitalized due to acute heart failure syndrome (AHFS).
Methods A total of 142 patients (71.4±14.0 years) hospitalized due to AHFS were enrolled. Measures of the pulsatile hemodynamics including central systolic blood pressure(SBP-c) and pulse pressure (PP-c), carotid-femoral pulse wave velocity (cf-PWV), and amplitude of the reflected pressure wave (Pb) from a decomposed carotid pressure wave were obtained before discharge. Serum levels of NT-proBNP and the thoracic fluid content (TFC) were also determined before discharge. Patients were followed for up to 2 years.
Results During a follow-up of 400±256 days (range 16 to 730 days), 75patients experienced cardiovascular events including re-hospitalization for heart failure, non-fatal myocardial infarction, non-fatal stroke, and mortality. The eventful patients were older, had lower estimated glomerular filtration rate (eGFR), and higher TFC, cf-PWV, SBP-c, PP-c, Pb, and levels of NT-proBNP. In multi-variate analysis, PP-c, and Pb but not cf-PWV were significant independent predictors of cardiovascular events, after accounting for age, eGFR, and NT-proBNP. Time series analysis demonstrated that Pb was the most significant hemodynamic predictor of cardiovascular events at 6 month (hazard ratio per SD, 1.5, 95% CI 1.2-2.0) and the significance declined with time. In contrast, cf-PWV was not significant predictor until 2 years after discharge (1.3, 95% CI 1.0-1.6).
Conclusion Arterial wave reflection indexed by Pb may be the most important pulsatile hemodynamic factor associated with the outcomes of AHFS. The prognostic importance of arterial stiffness indexed by cf-PWV may not manifest until 2 years after discharge in patients with AHFS.
- © 2011 by American Heart Association, Inc.