Open AccessLong‐term predictive value of stroke volume index obtained from right heart catheterization: Insights from the veterans affairs clinical assessment, reporting, and tracking program
Author(s) -
Bavry Anthony A.,
Hess Edward,
Waldo Stephen,
Barón Anna E.,
Kumbhani Dharam J.,
Bhatt Deepak L.,
Pandey Ambarish
Publication year - 2020
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23418
Subject(s) - medicine , stroke (engine) , stroke volume , proportional hazards model , hazard ratio , cardiology , cardiac catheterization , veterans affairs , cardiac index , cohort , hemodynamics , retrospective cohort study , surgery , confidence interval , cardiac output , heart rate , blood pressure , mechanical engineering , engineering
Background Right heart catheterization‐derived hemodynamic parameters have been associated with short‐term prognosis. Hypothesis Hemodynamic parameters will be associated with long‐term prognosis. Methods Retrospective cohort study from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program included patients who underwent an index right heart catheterization between 2008 and 2016. Cox proportional hazard models were used to examine the association between stroke volume index and all‐cause mortality. Results For the final cohort of 37 209 patients, mean follow‐up was 3.7 ± 2.5 years. All‐cause mortality was 42.0% in the low (<35 cc/beat/m 2 ) compared with 33.2% in the normal stroke volume index group (≥35 cc/beat/m 2 ). In adjusted analysis, low stroke volume was significantly associated with higher mortality risk (HR (95% CI) 1.14 (1.10‐1.18); P < .001) independent of clinical parameters. The area under the curve (AUC) for continuous measures of stroke volume index at predicting mortality in a Cox proportional hazard model was 0.56 at 3 years. When stroke volume index was combined with 14 clinical covariates, the AUC was 0.70 at 3 years. The addition of stroke volume index to these clinical covariates did not increase the discriminatory ability of the model at 1 year in a clinically meaningful way (integrated discrimination improvement index = 0.0021, 95% CI: 0.0010‐0.0034). Conclusions The long‐term prognostic value of right heart catheterization‐derived stroke volume index appears to be marginal. While there was a weak association of low stroke volume index and excess mortality, inclusion of this parameter to a set of clinical covariates did not improve prognostic discrimination.