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Prognostic Value of Right Ventricular Cardiac Power Output at Rest in Patients with Advanced Heart Failure.

Background
There is supporting evidence that normal right heart function is crucial for the maintenance of normal overall hemodynamics. The heart can be described as a hydraulic pump, and cardiac power reflects the hydraulic function of the heart. The present analysis aimed to evaluate the prognostic value of right ventricular cardiac power output (RV-CPO) at rest in patients with advanced heart failure (HF).


Methods
Between September 2010 and July 2013, 172 patients with advanced HF referred to our hospital were included in this study. Performing right-sided and left-sided heart catheterization simultaneously for each patient at baseline, we evaluated the hemodynamics with longitudinal follow-up of adverse outcomes such as cardiac mortality, ventricular assist device placement, and cardiac transplant (HTx).


Results
The threshold RV-CPO at rest value was 0.15 Watts. Increased RV-CPO (> 0.15 Watts) was correlated with an increase in adverse outcomes. Over 52 months, we observed 50 cardiac deaths, 10 HTx, and 12 ventricular assist device placements. The prognostic value of RV-CPO remained significant after adjustment for age, gender, ejection fraction, cardiac output, mean arterial pressure, valvular heart disease, diabetes, body surface area and mineralocorticoid receptor antagonist medication dummy (hazard ratio 0.052, 95% confidence interval 0.006 to 0.406, p = 0.005).


Conclusions
Higher RV-CPO at rest was an independent predictor of adverse outcomes. Therefore, RV-CPO could be integrated into the clinical evaluation used for individual risk stratification of patients with advanced HF in order to consider earlier HTx listing and/or earlier consideration for mechanical circulatory support device therapy.