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The Heartmate 3 risk score (HM3RS) was derived and validated from the MOMENTUM-3 trial population and was found to provide mortality risk prediction for patients undergoing HM3 implantation. The HM3RS predicted mortality at 1 and 2 years with an area under curve (AUC) of 0.76 and 0.71 respectively. We applied the HM3RS to a cohort of patients to assess predictive performance in a real-world population. This cohort included 345 patients from 6 academic centers implanted from 2018-2021 with a minimum of 1-year post-implant follow up. Patients were assessed for their eligibility for the MOMENTUM-3 trial based on inclusion and exclusion criteria. HM3RS risk discrimination was evaluated using time-dependent receiver operating characteristic (ROC) curve analysis for 1-year mortality, with analysis of the total cohort and stratified by study eligibility. Kaplan Meier curves for two-year mortality were constructed using HM3RS-based tertiles of risk. Out of the total cohort, 186 (54%) patients would have been excluded from the MOMENTUM-3 trial. The AUC of the HM3RS to predict 1-year survival in the total cohort was 0.61 (95% CI: 0.54-0.68, p=0.003; Figure 1A). For patients who would have qualified for MOMENTUM-3, the AUC was 0.67 (95% CI: 0.56-0.77, p=0.008; Figure 1B) and 0.56 (95% CI: 0.47-0.67, p=0.16; Figure 1C) for those who would have been excluded. KM curves (Figure 2A-C) of HM3RS tertiles did not discriminate risk. In this moderate-sized real-world cohort, the HM3RS provided risk discrimination but was less predictive than originally described. The HM3RS did not risk stratify patients who would have been excluded from MOMENTUM-3 trial. [ABSTRACT FROM AUTHOR]

Exercise right heart catheterization (RHC) is useful in the evaluation of unexplained dyspnea, particularly in diagnosing exercise-induced heart failure with preserved ejection fraction (HFpEF). Two diagnostic criteria are commonly utilized for supine exercise: 1) pulmonary artery wedge pressure (PAWP) at peak exercise ≥25 mmHg and 2) multi-point slope of the PAWP/cardiac output (CO) ratio ≥2 mmHg*min/L. Given marked intrathoracic pressures swings that can occur during exercise, an additional major controversy exists regarding how to assess pressures with respect to the respiratory cycle (end-expiratory vs averaged measures). We hypothesized that the PAWP/CO slope diagnostic criteria would be less impacted by differences in respiratory variation assessment than peak pressures criteria. A single-center retrospective review of patients who underwent supine exercise RHC for unexplained dyspnea from July 2018 to May 2021 was performed. End-expiratory pulmonary artery wedge pressures (PAWPexp) were manually assessed and computer generated PAWP averaged over the respiratory cycle (PAWPave) were also collected. Related-Sample Cochran's Q Test and Dunn post-hoc pairwise comparison with Bonferroni correction were utilized to determine differences in reclassification based on respiratory variation assessment. Fifty-one patients were identified and had an average H2FpEF score of 3.75 ± 2.04. Using peak PAWPexp criteria, 32 patients (62.7%) met criteria for HFpEF, whereas only 17 patients (33.3%) met criteria by peak PAWPave, a net reclassification of 15 patients (p<0.001). When using the PAWPexp/CO slope ≥2 for diagnosis, 41 (80.4%) of the patients met criteria, with reclassification of only 5 patients (36 patients, 70.6%) when using PAWPave/CO (p=0.960). Diagnostic criteria for exercise-induced HFpEF lead to significant differences in the number of patients ultimately diagnosed with HFpEF. However, the PAWP/CO slope methodology reduces the diagnostic variation introduced by respiratory cycle assessment differences. [ABSTRACT FROM AUTHOR]