Right heart catheterization in advanced systolic heart failure. What are the most useful haemodynamic parameters for risk stratification?

Central Illustration: Summary of the main results of the study. Haemodynamic independent predictors of major events in our study population and survival curves in subgroups divided according to baseline PVR, RAP and mPAP after the inotropic challenge. †: mortality; B: baseline; IC: inotropic challenge; mPAP: mean pulmonary arterial pressure; PA: pulmonary arterial; PAP: pulmonary arterial pressure; PAPP: pulmonary arterial pulse pressure; PPAPP: per cent of proportional PAPP; PCWP: pulmonary capillary wedge pressure; PVR: pulmonary vascular resistance; RAP: right atrial pressure; SHF: systolic heart failure; TPG: transpulmonary pressure gradient; WU: Wood units.▪ •Right heart catheterization is mandatory before heart transplantation.•Severe pulmonary hypertension is a contraindication to heart transplantation.•Few studies have analysed the prognostic impact of the acute vasodilatory tests.•Baseline RAP, baseline PVR and mPAP after inotropic challenge improve risk stratification in SHF. Previous studies have shown that pulmonary hypertension is a predictor of mortality in patients with systolic heart failure (SHF). Persistent pulmonary hypertension after a reactivity test is associated with a worse outcome after transplantation. Recent studies have shown the utility of different haemodynamic parameters. To define best haemodynamic parameters for risk stratification in patients with advanced systolic heart failure. We included 425 consecutive patients who underwent a right heart catheterization with an inotropic challenge if indicated. During a median (interquartile range) follow-up of 1.67 (0.49–4.49) years, there were 151 major cardiac events (126 cardiovascular deaths and 25 postoperative deaths after ventricular assist device implantation or heart transplantation). The most powerful independent predictors of major cardiac events were baseline right atrial pressure (RAP) (hazard ratio [HR]: 1.09, 95% confidence interval [CI]: 1.06–1.12; P