Evaluation of Resting Cardiac Power Output as a Prognostic Factor in Patients with Advanced Heart Failure

Yıldız, Ömer; Aslan, Gamze; Demirozu, Zumrut T.; Yenigun, Cemal Deniz; Yazicioğlu, Nuran

doi:10.1016/j.amjcard.2017.06.028

Cited by 29 publications

(38 citation statements)

References 23 publications

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“…To our knowledge, this is the first report of a case series where levosimendan is compared with inhaled pulmonary vasodilators for vasoreactivity testing, although a single case report has been published 7 . Overall, the safety profile and effects of levosimendan on the pulmonary vasculature and pulmonary vascular resistance were comparable with inhaled pulmonary vasodilators, but there was a significantly higher increase in cardiac index, left ventricular stroke work index, and cardiac power index, a known predictor of mortality in cardiogenic shock 27 and advanced heart failure 9 . Noticeably, levosimendan did not elicit systemic hypotension, and it was the only drug that reduced pulmonary artery wedge pressure as well as central venous pressure and right ventricular preload, an effect that we previously reported in an animal model 28 .…”

Section: Discussionmentioning

confidence: 97%

“…Indexed systemic and pulmonary vascular resistances were estimated as the ratio between the difference of mean arterial and central venous pressures (transsystemic gradient) or the transpulmonary gradient, respectively, and cardiac index while left and right ventricular stroke work indexes were obtained by multiplying stroke volume index by these gradients, respectively. Cardiac power index, a measure of effective hydraulic energy transmitted by the left ventricle to systemic arteries, was defined as the product between cardiac index and mean arterial pressure after conversion to Watts 9 . Pulmonary artery compliance was estimated as the ratio between stroke volume index and pulmonary artery pulse pressure.…”

Section: Methodsmentioning

confidence: 99%

“…Cardiac power index, a measure of effective hydraulic energy transmitted by the left ventricle to systemic arteries, was defined as the product between cardiac index and mean arterial pressure after conversion to Watts. 9 Pulmonary artery compliance was estimated as the ratio between stroke volume index and pulmonary artery pulse pressure.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of levosimendan, NO, and inhaled iloprost for pulmonary hypertension reversibility assessment in heart transplant candidates

et al. 2021

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Aims Assessing reversibility of pulmonary vascular changes through vasoreactivity testing (VRT) optimizes end-stage heart failure patient selection for heart transplant. All efforts should be made to unload the left ventricle and reduce pulmonary vascular resistance to effectively exclude irreversible pulmonary hypertension. Methods and results We reviewed our centre's cardiac transplant registry database (2009-2017) for VRT and compared haemodynamic responses with 40 ppm inhaled NO (n = 14), 14-17 μg inhaled iloprost (n = 7), and 24 h 0.1 μg/kg/min intravenous levosimendan (n = 14). Response to levosimendan was assessed by repeat right heart catheterization within 72 h. Baseline clinical and haemodynamic features were similar between groups. VRT was well tolerated in all patients. All drugs effectively reduced pulmonary artery pressures and transpulmonary gradient while increasing cardiac index, although levosimendan had a greater impact on cardiac index increase (P = 0.036). Levosimendan was the only drug that reduced pulmonary artery wedge pressure (P = 0.004) and central venous pressures (P < 0.001) and increased both left and right ventricular stroke work indexes (P = 0.020 and P = 0.042, respectively) and cardiac power index (P < 0.001) compared with NO and iloprost. Right ventricular end-diastolic pressures and central venous pressure were only decreased by levosimendan. The rate of positive responses (≥10 mmHg decrease or final mean pulmonary artery pressure ≤40 mmHg with increased/unaltered cardiac index) was lower with inhaled iloprost (14%) than with either levosimendan or NO (71% and 64%, respectively; P < 0.05). Conclusions Levosimendan may be a safe and effective alternative for pulmonary hypertension reversibility assessment or a valuable pre-test medical optimization tool in end-stage heart failure patient assessment for heart transplantation offering extended haemodynamic benefits. Whether it increases the rate of positive responses or allows a better selection of candidates to heart transplantation remains to be established.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

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Comparison of levosimendan, NO, and inhaled iloprost for pulmonary hypertension reversibility assessment in heart transplant candidates

et al. 2021

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“…In severe heart failure the baseline resting CPO is reduced (Yildiz et al. ). The amount of power that can be generated above the resting baseline is known as the cardiac reserve (Cotter et al.…”

Section: Discussionmentioning

confidence: 99%

“…; Yildiz et al. ). For patients admitted to an intensive care unit (ICU) with cardiogenic shock, a substantial drop in cardiac power index (CPI = CPO/body surface area) was associated with an increased 28 day mortality (Torgersen et al.…”

Section: Introductionmentioning

confidence: 97%

Post cardiac surgery stunning reduces stroke work, but leaves cardiac power output unchanged in patients with normal ejection fraction

et al. 2018

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This study assesses positional changes in cardiac power output and stroke work compared with classic hemodynamic variables, measured before and after elective coronary artery bypass graft surgery. The hypothesis was that cardiac power output was altered in relation to cardiac stunning. The study is a retrospective analysis of data from two previous studies performed in a tertiary care university hospital. Thirty‐six patients scheduled for elective coronary artery bypass graft surgery, with relatively preserved left ventricular function, were included. A pulmonary artery catheter and a radial artery catheter were placed preoperatively. Cardiac power output and stroke work were calculated through thermodilution both supine and standing prior to induction of anesthesia and again day one postoperatively. Virtually all systemic hemodynamic parameters changed significantly from pre‐ to postoperatively, and from supine to standing. Cardiac power output was maintained at 0.9–1.0 (±0.3) W both pre‐ and postoperatively and from supine to standing on both days. Stroke work fell from pre‐ to postoperatively from 1.1 to 0.8 J (P < 0.001), there was a significant fall in stroke work with positional change preoperatively from 1.1 to 0.9 J (P < 0.001). Postoperatively the stroke work remained at 0.8 J despite positional change. Cardiac power output was the only systemic hemodynamic variable which remained unaltered during all changes. Stroke work appears to be a more sensitive marker for temporary cardiovascular dysfunction than cardiac power output. Further studies should explore the relationship between stroke work and cardiac performance and whether cardiac power output is an autoregulated intrinsic physiological parameter.

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Prognostic value of resting cardiac power index depends on mean arterial pressure in dilated cardiomyopathy

et al. 2021

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AimsIn recent decades, haemodynamic parameters have been estimated for risk stratification and determining treatment strategies for patients with non-ischaemic dilated cardiomyopathy (DCM). In various invasive procedures, the cardiac pumping capability is defined as cardiac power output (CPO), which is calculated by multiplying cardiac output by the mean arterial pressure. Lower CPO values in advanced heart failure predict adverse outcomes. However, few studies discuss the prognostic value of CPO in mild-to-moderate phase patients. This study aimed to determine the value of the cardiac power index (CPI) obtained from the resting CPO for predicting the prognosis of patients with New York Heart Association Functional Class II or III DCM. Methods and results From March 2000 to January 2020, a total of 623 cardiomyopathy patients were evaluated for haemodynamic parameters. Patients with secondary cardiomyopathy, ischaemic cardiomyopathy, valvular heart disease, and Class IV cardiomyopathy were excluded. A total of 176 DCM patients fulfilled the criteria for inclusion. Patients were 51.7 ± 12.5 years old (mean ± standard deviation) with a mean left ventricular ejection fraction of 32.1 ± 9.2%. The patients were divided into two groups by their median CPI (CPI < 0.52, low-CPI; CPI ≥ 0.52, high-CPI). No significant differences were found in the left ventricular end-diastolic diameter, left ventricular ejection fraction, or pulmonary arterial wedge pressure between the groups. The probability of cardiac event-free survival was significantly lower for low-CPI than for high-CPI groups by Kaplan-Meier analysis (P = 0.012), even with no significant difference between the high and low cardiac index groups (P = 0.069). Furthermore, Cox proportional hazards regression analysis revealed that, in addition to the CPI, the systolic and mean arterial pressure involved in CPI calculation were independent predictors of cardiac events. Indeed, among these factors, mean arterial pressure had the strongest prognostic ability. Conclusions Although CPI is effective for stratifying DCM and predicting cardiac events in patients with Class II/III DCM, this prognostic value depends on mean arterial pressure.

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Evaluation of Resting Cardiac Power Output as a Prognostic Factor in Patients with Advanced Heart Failure

Cited by 29 publications

References 23 publications

Comparison of levosimendan, NO, and inhaled iloprost for pulmonary hypertension reversibility assessment in heart transplant candidates

Comparison of levosimendan, NO, and inhaled iloprost for pulmonary hypertension reversibility assessment in heart transplant candidates

Post cardiac surgery stunning reduces stroke work, but leaves cardiac power output unchanged in patients with normal ejection fraction

Prognostic value of resting cardiac power index depends on mean arterial pressure in dilated cardiomyopathy

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