Abstract Body (Do not enter title and authors here): Background
Central aortic hemodynamics significantly affect left ventricular function and clinical outcomes in patients with heart failure (HF). We proposed that energetic hemodynamic parameters could offer a more detailed understanding and a stronger correlation with left ventricular function and outcomes, compared to traditional pressure-based parameters.
Methods
A total of 166 patients (61 years, 26.5% women) hospitalized due to HF (24% with preserved systolic function) were enrolled. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured at admission. At discharge, we assessed the augmentation index (AI), backward pressure (Pb) and carotid-femoral pulse wave velocity (cf-PWV) using tonometry, as well as aortic doppler flow. Energetic hemodynamic parameters were calculated by integrating pressure multiplied by flow over time.
Results
While subjects with a left ventricular ejection fraction (LVEF) <50% exhibited significantly lower AI and Pb compared to those with LVEF of ≥50%, aortic and carotid energetic hemodynamic parameters were also significantly lower in patients with impaired LVEF. After adjusting for age, sex, estimated glomerular filtration rate, and NT-proBNP, the total and mean energy of the carotid artery were independently associated with mortality [hazard ratios and 95% confidence intervals: 1.009 (1.004-1.015) and 1.018 (1.006-1.026), respectively]. Subgroup analyses consistently demonstrated the prognostic value of energetic hemodynamics across different HF phenotypes.
Conclusion
The study indicated that energetic hemodynamic parameters, especially the total and mean energy of the carotid artery, correlated with long-term survival, irrespective of LVEF. Notably, these energetic hemodynamics surpassed cf-PWV in their correlation with left ventricular systolic function.