Abstract 14575: Pupillary Reflex as an Independent Marker of Mortality in Decompensated Heart Failure. A Longitudinal and Prospective Study

Introduction: In heart failure (HF) compensatory mechanisms are triggered to maintain adequate cardiac output. Among them, hyperactivation of sympathetic nervous system (SNS) is one of the main ones and carries a worse prognosis. The pupillary reflex depends on the SNS. Aims: The aim of the study is to analyze whether changes in the pupillary reflex in HF are useful in the prognostic stratification of these patients. Hypothesis: Pupillary reflex may be a prognostic marker in patients with decompensated HF. Methods: We prospectively and consecutively included 107 patients admitted with decompensated HF. Quantitative pupillometry was performed with the NeuroOptics pupillometry during the first 24 hours after admission and prior to discharge. The basal maximum pupillary diameter (BMPD) before contraction, was measured. Results: Of the 107 patients, 51% were women and 49% men, mean age was 79 +/- 10 years, 77% had hypertension, and 34% Diabetes.6 patients died during admission, 11 died in the first month after discharge and 4 patients were readmitted in the first month.Of the patients who died, all had on admission BMPD > 3.8 mm. No patient with a BMPD < 3.7 mm died. The area under curve ROC for predicting the combined endpoint of 1- month mortality and admissions for HF using BMPD was 0.823. The BMPD presented a weak correlation with heart rate and ejection fraction. It did not correlate with age, gender, BNP, mean E/e, left atrial volume indexed, creatinine, hematocrit, sodium. Conclusions: Patients with decompensated HF presented at admission a higher BMPD. This supports the hypothesis that decompensated HF present a hyperactivation of the SNS that promotes mydriasis. BMPD is provides a good independent predictor marker of in-hospital and 1-month mortality in patients admitted with HF. Pupillometry may be a new, non-invasive and simple tool that helps in the prognostic stratification of acute HF patients.