Abstract 15227: Kussmaul Physiology is an Independent Predictor of Adverse Clinical Outcomes and Mortality in Patients With Heart Failure
Background: Paradoxical inspiratory rise in right atrial pressure (RAP) - Kussmaul physiology (KP) - has been described in heart failure (HF). In this study, we investigated the clinical and hemodynamic correlates, and prognostic significance of KP in patients referred for heart transplant assessment.
Methods: We included 90 consecutive patients with HF (Age 53±12 years, 86% Male) referred for assessment for transplantation. KP was defined as inspiratory rise in RAP during cardiac catheterization. We evaluated all-cause mortality and a composite end-point of mortality, need for ventricular assist device implantation (bridge to transplantation) and post-transplant right ventricular failure (defined as the need for right ventricular mechanical support) over a mean follow up of 379±227 days.
Results: KP was demonstrated in 39/90 (43%) of the patients. There were no significant differences in demographics and co-morbidities between patients with or without KP. Peak VO2 were comparable, but ventilation slope were higher in patients with KP (p<0.01). Patients with KP had lower left ventricular ejection fraction and tricuspid annular plane systolic excursion; higher NT-proBNP (p<0.01) and lower serum sodium (p=0.02). Catheter studies revealed more adverse hemodynamics in patients with KP, characterised by lower cardiac index and LV stroke work index, higher RA, pulmonary artery and wedge pressures, and pulmonary vascular resistance index. Pulmonary artery capacitance was lower in patients with KP (all p<0.05). Hence, patients with KP were more likely to be considered unsuitable for transplantation due to adverse pulmonary hemodynamics (36% vs 13%, p<0.05), had a higher incidence of post-transplant RV failure and overall mortality (41% vs 12%, p<0.05). KP was an independent predictor of all-cause mortality and the composite end-point (both p<0.01) in Cox proportional-hazard model, adjusting for baseline variables; and after adjusting for RAP and either Heart Failure Survival Score or Seattle Heart Failure Model (all p≤0.01).
Conclusion: Kussmaul physiology is common in patients with HF referred for transplantation, associated with poor candidacy for transplantation and independently associated with mortality.
- © 2013 by American Heart Association, Inc.