Abstract 14388: Aortic Pulsatility Index Strongly Predicts Clinical Outcomes in Heart Failure Patients: A Sub-analysis of the Escape Trial

Introduction: Aortic pulsatility index (API), calculated as (systolic - diastolic blood pressure)/pulmonary capillary wedge pressure, is a novel hemodynamic measurement representing cardiac filling pressures and contractility. Hypothesis: API would better predict clinical outcomes than traditional hemodynamic metrics of cardiac function in decompensated heart failure patients. Methods: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial individual-level data were used. API, cardiac power output (CPO), Fick cardiac index (CI), and pulmonary artery pulsatility index (PAPI) were calculated after final hemodynamic-monitored optimization. The primary outcome, assessed by univariable analysis, was combined death or need for heart transplant or left ventricular assist device at six months. Receiver operator characteristic (ROC) analyses were used to determine the cutoff value, from which Kaplan-Meier (KM) curves were constructed. Results: A total of 433 patients were enrolled in the ESCAPE trial, of which 155 had accurate final hemodynamic data. Of these, 45 (29%) experienced the primary outcome. Final API measurements predicted the primary outcome, OR 0.45 (95% CI 0.30-0.70, p<0.001), while CI, CPO, and PAPI did not. ROC analyses of final advanced hemodynamic measurements indicated API best predicted the primary outcome with a cutoff (sensitivity, specificity, correctly classified, AUC) of 2.9 (76.2%, 55.3%, 61.4%, 0.71), compared to CPO 0.69 (57.8%, 57.8%, 57.4%, 0.57), CI 2.2 (50.0%, 48.2%, 48.7%, 0.52), and PAPI 2.6 (60.5%, 64.5%, 63.3%, 0.64). KM analyses indicated API (83.5% vs 58.4%, p=0.001) and PAPI (78.3% vs 59.0%, p=0.03) were predictive of freedom from the primary outcome, but not CPO or CI. Conclusions: The novel hemodynamic measurement API better predicted clinical outcomes in the ESCAPE trial when compared to traditional invasive hemodynamic metrics of cardiac function.

Abstract 15111: Aortic Pulsatility Index Predicts Heart Failure Rehospitalization: A Sub-analysis of the Escape Trial

Introduction: Aortic pulsatility index (API), calculated as (systolic blood pressure - diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP), is a novel hemodynamic measurement representing cardiac filling pressures and contractility. Hypothesis: API would predict heart failure hospitalizations in acutely decompensated heart failure participants in the Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness (ESCAPE) trial. Methods: From the ESCAPE trial individual-level data API, cardiac power output (CPO), and pulmonary artery pulsatility index (PAPI) were calculated, as well as reported routine invasive hemodynamics at baseline and after final hemodynamic-monitored optimization. Outcomes assessed were need for any rehospitalization and time to any first rehospitalization. Univariable analysis was conducted to assess rehospitalization. Negative binomial regression was used to analyze duration of time from discharge to first rehospitalization. Results: A total of 433 patients were enrolled in the ESCAPE trial. 189 patients had complete, accurate baseline hemodynamic data and were included in this analysis. No baseline hemodynamic measurements were associated with either outcome, except pulmonary artery (PA) diastolic pressure which predicted rehospitalization (OR 1.05 (95% CI 1.00-1.05, p= 0.02). Final API, OR 0.75 (95% CI 0.60-1.00, p= 0.03) and PAPI, OR 0.90 (95% CI 0.80-1.00, p= 0.03) predicted the need for any rehospitalization. Final API, OR 0.84 (95% CI 0.73-0.97, p= 0.02), and PA diastolic pressure, OR 1.03 (95% CI 1.01-1.06, p= 0.02), were associated with duration of time from discharge to any first hospitalization. Conclusions: The novel hemodynamic measurement API better predicted rehospitalization and time to rehospitalization in the ESCAPE trial when compared to routine, and other advanced invasive hemodynamic measurements.

Anesthetic management of modified electroconvulsive therapy for a patient with coronary aneurysms: a case report

Background Modified electroconvulsive therapy (m-ECT) is utilized worldwide as an effective treatment for drug-resistant psychiatric disorders. However, during m-ECT, treatment of hypotension and hypertension in response to rapid hemodynamic changes is required. We used noninvasive continuous blood pressure monitoring system for continuous hemodynamic measurement during m-ECT. Case presentation The patient was a 77-year-old man with depression complicated by coronary artery aneurysms (CAAs). We managed general anesthesia during m-ECT by using the ClearSight™ system (Edwards Lifesciences Corp, Irvine, CA, USA) for hemodynamic measurement. As a result, we performed a total of 10 m-ECTs. No rupture of CAAs or myocardial ischemia occurred and depressive symptoms improved. Conclusion We successfully managed the anesthesia in m-ECT for a depressed patient with CAAs without complications by using the ClearSight™ system, which was used for the effective management of circulatory fluctuations.