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    Evaluation of Resting Cardiac Power Output as a Prognostic Factor in Patients with Advanced Heart Failure
    (Excerpta Medica Inc-Elsevier Science Inc, 2017) Yildiz, Omer; Asian, Gamze; Demirozu, Zumrut T.; Yenigun, Cemal Deniz; Yazicioglu, Nuran
    If the heart is represented by a hydraulic pump, cardiac power represents the hydraulic function of the heart. Cardiac pump function is frequently determined through left ventricular ejection fraction using imaging. This study aims to validate resting cardiac power output (CPO) as a predictive biomarker in patients with advanced heart failure (HF). One hundred and seventy-two patients with HF severe enough to warrant cardiac transplantation were retrospectively reviewed at a single tertiary care institution between September 2010 and July 2013. Patients were initially evaluated with simultaneous right-sided and left sided cardiac catheter-based hemodynamic measurements, followed by longitudinal follow-up (median of 52 months) for adverse events (cardiac mortality, cardiac transplantation, or ventricular assist device placement). Median resting CPO was 0.54 W (long rank chi-square = 33.6; p < 0.0001). Decreased resting CPO (<0.54 W) predicted increased risk for adverse outcomes. Fifty cardiac deaths, 10 cardiac transplants, and 12 ventricular assist device placements were documented. The prognostic relevance of resting CPO remained significant after adjustment for age, gender, left ventricular ejection fraction, mean arterial pressure, pulmonary vascular resistance, right atrial pressure, and estimated glomerular filtration rate (HR, 3.53; 95% confidence interval, 1.66 to 6.77; p = 0.0007). In conclusion, lower resting CPO supplies independent prediction of adverse outcomes. Thus, it could be effectively used for risk stratification in patients with advanced HF. (C) 2017 Elsevier Inc. All rights reserved.
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    Prognostic value of left ventricular stroke work index in patients with advanced heart failure
    (2022) Yenigün, Cemal; Yildiz, Omer
    Aim: The impact of reduced myocardial contractility on patients’ outcomes with advanced heart failure (HF) and the correct measurement units for its measure is most important. The present work aims to evaluate the prognostic value of the left ventricular stroke work index (LVSWI), which is considered a measure of myocardial contractility, in patients with advanced HF. Material and Methods: Between September 2010 and July 2013, 172 patients with advanced HF admitted to the hospital to guide the specified therapies were included in this study. At baseline, patients were assessed with cardiac catheter-based hemodynamic measurements, ensued by the longitudinal follow-up (median of 52 months) for adverse outcomes (cardiac mortality, ventricular assist device (VAD) placement, and heart transplant (HTx)). Results: Median LVSWI was 16 cJ/m2. Decreased LVSWI (
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    Prognostic Value of Right Ventricular Cardiac Power Output at Rest in Patients with Advanced Heart Failure
    (Taiwan Soc Cardiology, 2021) Yildiz, Omer; Yenigun, Cemal Deniz
    Background: There is supporting evidence that normal right heart function is crucial for the maintenance of normal overall hemodynamics. The heart can be described as a hydraulic pump, and cardiac power reflects the hydraulic function of the heart. The present analysis aimed to evaluate the prognostic value of right ventricular cardiac power output (RV-CPO) at rest in patients with advanced heart failure (HF). Methods: Between September 2010 and July 2013, 172 patients with advanced HF referred to our hospital were included in this study. Performing right-sided and left-sided heart catheterization simultaneously for each patient at baseline, we evaluated the hemodynamics with longitudinal follow-up of adverse outcomes such as cardiac mortality, ventricular assist device placement, and cardiac transplant (HTx). Results: The threshold RV-CPO at rest value was 0.15 Watts. Increased RV-CPO (> 0.15 Watts) was correlated with an increase in adverse outcomes. Over 52 months, we observed 50 cardiac deaths, 10 HTx, and 12 ventricular assist device placements. The prognostic value of RV-CPO remained significant after adjustment for age, gender, ejection fraction, cardiac output, mean arterial pressure, valvular heart disease, diabetes, body surface area and mineralocorticoid receptor antagonist medication dummy (hazard ratio 0.052, 95% confidence interval 0.006 to 0.406, p = 0.005). Conclusions: Higher RV-CPO at rest was an independent predictor of adverse outcomes. Therefore, RV-CPO could be integrated into the clinical evaluation used for individual risk stratification of patients with advanced HF in order to consider earlier HTx listing and/or earlier consideration for mechanical circulatory support device therapy.