The impact of left ventricular end diastolic pressure on adverse clinical outcome between subjects with preserved and reduced left ventricular ejection fraction (RF_FR 369)

Friday, January 31, 2025

1:50 PM – 2:00 PM East Coast USA Time

Location: Blue Room PreFunction

Presenting Author(s)

JC

J. Jane J. Cao, MD

St. Francis Hospital, The Heart Center

Primary Author(s)

Jane Cao, MD MPH FACC

System Director of Advanced Cardiac Imaging
St. Francis Hospital and The Heart Center

Co-Author(s)

JW

Jonathan Weber, MPH

Research Analyst
St. Francis Hospital, The Heart Center
KB

Kaylee Bressler, MSc, BSc

Research Volunteer
St. Francis Hospital & Heart Center
CT

Charles Tarantino, BSc

Research Associate
St. Francis Hospital & Heart Center
KS

Katie Sandhovel, BSc

Research Volunteer
St. Francis Hospital & Heart Center
MC

Matthew Cannata, BSc

Scholar
St. Francis Hospital & Heart Center
EC

Emma Caron, BSc

Scholar
St. Francis Hospital & Heart Center
YC

Yasemin Ciftcikal, BA

Scholar
St. Francis Hospital & Heart Center
SQ

Sophia Qiu, BSc

Clinical Scholar
St. Francis Hospital & Heart Center

Background: Elevated left ventricular end diastolic pressure (LVEDP) is an important risk factor for decompensated heart failure that is associated with significant morbidity and mortality. The aim of this study was to understand the prognostic value of LVEDP for adverse clinical outcomes between patients that had preserved or reduced LV ejection fraction (LVEF).

Methods: This retrospective cohort study included consecutive subjects who underwent invasive hemodynamic measurement of LVEDP and were referred for clinical CMR evaluation within 3 days. Demographic information was extracted from medical records and cardiac chamber sizes/volumes were measured on CMR images using commercial software. We used Youden’s index (J = Sensitivity + specificity – 1) to identify the optimal cut point for LVEDP to predict a composite outcome consisting of hospitalized heart failure exacerbation and all-cause mortality. The Kaplan-Meier method was used to examine the association between strata of elevated LVEDP and reduced LVEF with the composite outcome. Cox proportional hazards models were used to estimate hazards of the composite outcome, adjusted for age, gender, BMI, hypertension, diabetes, and coronary artery disease.

Results:

Among 658 subjects included in our sample, the average age was 64 ± 13 years, 64% were male, and 349 (53%) had reduced LVEF < 50%. After a mean follow-up period of 23 ± 24 months, 113 (17%) patients reached the composite outcome. LVEDP ≥22 mmHg (32% of subjects) was identified as the optimal cut point predicting the outcome, which was similar for patients with preserved and reduced LVEF. Outcome incidence grew from 36 to 69 per 1000 person-years comparing LVEDP < 22 mmHg with ≥22 mmHg among those with preserved EF. The incidence was higher among those with reduced EF in which outcome incidence grew from 103 to 182 per 1000 person-years comparing two LVEDP strata (Figure 1). In the Cox proportional hazards regression analysis, the adjusted hazards of the composite outcome increased by 17% for every 5 mmHg increase in LVEDP (95% confidence limits [CL] 1.04-1.31). Subjects with LVEDP ≥22 mmHg had 2.04 times the hazards of the outcome compared to subjects with LVEDP < 22 mmHg (95% CL 1.35-3.10).

Conclusion: While the optimal cut point of LVEDP predicting a composite outcome was the same, the probability of event-free survival was lower among those with reduced than those with preserved EF. Our findings suggest that there are important differences in the hemodynamic impact on adverse outcomes between subjects with preserved and reduced LVEF.