Prognostic Value of Wave Intensity in Patients Awaiting Heart Transplantation

Abstract

Background: Prospective comparative studies to predict the risk of hemodynamic deterioration in patients referred for transplantation were performed on the basis of standard invasive and non-invasive data and new wave intensity (WI) parameters.

Methods and results: Study group 1 consisted of 150 consecutive outpatients (age 48.7±12 years; 110 men) with endstage dilative cardiomyopathy. Group 2, consisting of 11 consecutive patients (age 50±11 years; 6 men) with sinus rhythm and “true” decompensation, was used to create “critical” values of WI. There were no demographic or somatic (weight and height) differences between the groups. The follow-up period of ambulatory patients was 31±8 months. Non-invasive WI was studied in the common carotid artery. Complete invasive and noninvasive data were also recorded on the day of investigation. During follow-up 44 pts were lost: there were 15 cardiac deaths (10%), life-saving ventricular assist device implantation in 10 (6.6%) and transplantation in 19 (12.7%). For statistical purposes this group was named “events” group B (n=44). A predisposing factor for events (death, “true” decompensation and “urgent” transplantation in ambulatory patients) was low first peak (“critical” value assessed in group 2 <4100 mmHg*s³) (OR 45.6, CI 14.5-143.3, p<0.001). Less powerful predictors of the risk of deterioration were PCP, diastolic PAP and E/A mitral wave relation (p=0.05).

Conclusions: The new ventricular-arterial coupling parameter 1st peak of WI can potentially be used to distinguish patients at high risk for true deterioration and death.