Prognostic Role of Cardiac Power Index in Patients with Biopsy-Proven Inflammatory Cardiomyopathy - European Medical Journal

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Prognostic Role of Cardiac Power Index in Patients with Biopsy-Proven Inflammatory Cardiomyopathy

1 Mins
Cardiology
Authors:
*Mohamed Gayed,1 Marc-Alexander Ohlow2

1. Coburg Hospital, Coburg, Germany
2. Zentralklinik Bad Berka, Bad Berka, Germany
*Correspondence to [email protected]

Disclosure:

The authors have declared no conflicts of interest.

Citation:
EMJ Cardiol. ;6[1]:61-62. Abstract Review No. AR6..
Keywords:
Cardiac power index (CPI), heart failure, inflammatory cardiomyopathy

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND

Most patients with acute myocarditis and mild cardiac involvement recover without long-term sequelae. However, those patients with advanced cardiac involvement may have a more varied outlook. Of these, at least one-third of patients will have residual ventricular dysfunction, around 25% will progress to transplantation or death, and the remainder will recover and have normal ventricular function.1,2

Various diagnostic tests are used to assess heart function, but a test that predicts the prognosis of heart failure and thereafter helps clinicians to intervene earlier in those patients with a poor prognosis is still lacking.3 Cardiac power index (CPI) (mean arterial blood pressure x cardiac index x 0.0022) has been demonstrated to be an important haemodynamic predictor of mortality and adverse events in patients with various cardiac diseases.4-9 However, its prognostic impact on patients with inflammatory cardiomyopathy is less well investigated.

METHODS

All patients with biopsy-proven inflammatory cardiomyopathy undergoing invasive haemodynamic assessment with longitudinal follow-up were retrospectively analysed and classified into two groups. Group 1 represented patients with a normal CPI (≥0.5 W/m²) and Group 2 represented patients with a diminished CPI (<0.5 W/m²). The combined primary endpoint was cardiac death, aborted sudden cardiac death, heart transplantation, and left ventricular assist device implantation.

RESULTS

One hundred and sixty-seven patients (mean age: 60±11 years; 71% male) were available for analysis and the mean CPI was 0.43±0.14 W/m2 (Group 1: 0.62±0.12 W/m2 versus Group 2: 0.37±0.083 W/m2; p<0.001). At presentation, a lower CPI was associated with lower systolic, diastolic, and mean blood pressure; lower ejection fraction; lower cardiac output; higher pulmonary vascular resistance; and higher right ventricular pressure.

Over a mean of 3.6±2.4 years of follow-up, there were 7 deaths, 12 incidences of aborted sudden cardiac death, 3 transplants, and 2 left ventricular assist device placements. Diminished CPI was associated with an increased incidence of the combined primary endpoint (hazard ratio: 3.4; 95% confidence interval: 1.29–8.98). Event-free survival by Kaplan–Meier estimate was significantly lower in Group 2 than Group 1 (80.1% versus 97.4%, respectively; p<0.01).

CONCLUSION

In conclusion, patients with inflammatory cardiomyopathy and a low CPI had an increased incidence of the combined primary endpoint during long-term follow-up compared to patients with a normal CPI.

References
Peter P et al., “Myocarditis," Libby P et al. (eds.), Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine (2007) 8th edition, Philadelphia: Elsevier Saunders. Felker GM et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342(15):1077. Garcia J. Cardiac power output, its role in defining heart failure for future mechanical circulatory support [Master’s thesis]. Tucson, Arizona: University of Arizona; 2011. Jakovljevic DG et al. Comparison of cardiac power output and exercise performance in patients with left ventricular assist devices, explanted (recovered) patients, and those with moderate to severe heart failure. Am J Cardiol. 2010;105(12):1780-5. Jakovljevic DG et al. The effect of aerobic versus resistance exercise training on peak cardiac power output and physical functional capacity in patients with chronic heart failure. Int J Cardiol. 2010;145(3):526-8. Lang CC et al. Peak cardiac power output, measured noninvasively, is a powerful predictor of outcome in chronic heart failure. Circ Heart Fail. 2009;2(1):33-8. Shelton RJ et al. Cardiac output does not limit submaximal exercise capacity in patients with chronic heart failure. Eur J Heart Fail. 2010;12(9):983-9. Torgersen C et al. Hemodynamic variables and mortality in cardiogenic shock: A retrospective cohort study. Crit Care. 2009;13(5):R157. Mendoza DD et al. Cardiac power output predicts mortality across a broad spectrum of patients with acute cardiac disease. Am Heart J. 2007;153(3):366-70.

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