Excessive arterial wave reflections play an important role in the pathogenesis of acute heart failure (AHF). Alternatively, the pulsatile hemodynamics can be analyzed by a reservoir wave model incorporating elements from both reservoir functions and wave analysis. The present study investigated the prognostic values of the arterial reservoir functions in AHF.Design and Method:
A total of 220 AHF patients (70 ± 15 years, 76.8% men, 66.8% HFrEF) were enrolled and followed for one year after discharge. Measures of the pulsatile hemodynamics, including carotid-femoral pulse wave velocity (cf-PWV), carotid pulse pressure (PPc), carotid augmentation index (cAI), carotid augmentation pressure (cAP), the amplitude of reflected wave (Pb), and those based on the reservoir wave model: excess pressure integral (XSPI), reservoir pressure integral (PRI), amplitude of reservoir pressure (Pres), and systolic and diastolic rate constant, were obtained before discharge.Results:
During a mean follow-up of 305 ± 108 days, a total of 91 subjects incurred either AHF re-admission or mortality. Patients with post-discharge events were older, had lower eGFR, higher cf-PWV, PPc, cAI, cAP and Pb, and higher XSPI, Pres, and diastolic rate constant. PPc, Pb, XSPI and diastolic rate constant remained significantly independently associated with the post-discharge events (HR and 95%CI per-1SD: 1.36, 1.10–1.68; 1.14, 1.04–1.24; 1.29,1.04–1.59; 1.37,1.03–1.82, respectively) in a multi-variable Cox model accounting for age, sex, eGFR and NTproBNP. Using a backward stepwise model, both XSPI and diastolic rate constant but not PPc or Pb, persistently stayed in the prediction model (1.37, 1.11–1.70 and 1.56, 1.16–2.09, respectively). Combining PPc and diastolic rate constant further stratified the risks of the patients. (Figure) In addition, the add-on of XSPI and diastolic rate constant to the prediction model of baseline characteristics and PPc improved the net reclassification by 7.2% (P = 0.044).Conclusions:
Arterial reservoir functions measured by the reservoir wave model are independent prognostic indicators in patients with AHF. Combining parameters of wave reflections arterial reservoir functions may further improve the prediction of post-discharge adverse events.