Cardiac power and the association with heart failure and cardiovascular death in the general population.

Background: Cardiac power (CP) integrates echocardiographic and clinical parameters of hemodynamics, yet its prognostic value within the general population remains unexplored. This study investigated the association between CP and incident heart failure (HF) and cardiovascular (CV) death in the general population.

Methods: In this prospective cohort study, we measured CP in a total of 4022 individuals from the general population without prior HF. CP was expressed in W/100 g of left ventricular (LV) myocardium. The outcome was a composite of incident HF and CV death and the association between CP and the composite outcome was explored in Cox regression models.

Results: During a median follow-up of 3.5 years (IQR 2.6;4.4 years), 134 (3.3 %) individuals experienced the composite outcome. Left ventricular (LV) ejection fraction (LVEF) significantly modified the association between CP and outcome (pinteraction < 0.001). Stratifying the population according to LVEF, CP had no prognostic value in LVEF ≥50 % (p = 0.81). In individuals with LVEF <50 %, CP remained significantly associated with the composite outcome after multivariable adjustment (HR 1.22 per 0.1 W decrease, 95 % CI: 1.06-1.41, p = 0.005). Individuals with reduced LVEF and CP <0.84 W had the highest risk of the composite outcome (SHR 7.45 per 0.1 W decrease, CI: 4.63-12.00, p < 0.001.)

Conclusion: CP was associated with incident HF and CV death in the general population, however, LVEF significantly modified this relationship. CP was independently associated with incident HF and CV death in individuals with LVEF <50 % but not individuals with LVEF ≥50 %.