Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?

Ali Doğan

doi:10.5798/dicletip.755709

Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?

Abstract

Objective: The effect of pulmonary artery pulsatility index (PAPi) on mortality in patients with advanced chronic heart failure (HF). Methods: The study included 53 patients with advanced chronic HF, with ejection fraction below 30%, who underwent right and left catheterization. Two groups were formed according to the development of cardiac mortality. Results: Of 53 patients in the study group, 18 patients developed cardiac mortality (33.9%). While male gender and peripheral artery disease were more in the cardiac mortality group, CRP level was also seen more in this group. As stroke volume, aortic pressures, left ventricular systolic pressure were lower in the cardiac mortality group, right atrium pressure (RAP) was higher. PAPi was associated with cardiac mortality and lower in this group (P = 0.001). According to univariate analysis, PAPi and RAP were among predictors of cardiac mortality. However, multivariate analysis indicated that only RAP was an independent predictor. PAPi threshold value for cardiac mortality was calculated as 2.9 (88.9% sensitivity and 74.3% specificity). Conclusion: PAPi is related with cardiac mortality in advanced HF. However, it is not an independent predictor. PAPi is mostly dependent on right atrial pressure.

Keywords

advanced heart failure,cardiac mortality

References

1. Kalmanovich E, Audurier Y, Akodad M, et al. Management of advanced heart failure: a review. Expert Rev Cardiovasc Ther. 2018; 16: 775-94
2. Metra M, Ponikowski P, Dickstein K, et al. Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2007; 9: 684-94.
3. Merlo M, Gobbo M, Stolfo D, et al The Prognostic Impact of the Evolution of RV Function in Idiopathic DCM. Jacc-Cardiovasc Imag. 2016; 9: 1034-42.
4. Akıl MA, Ertas F, Kaya H, et al. Comparison of right ventricular functions according to infarct localization using advanced echocardiographic methods in myocardial infarction with ST elevation. Dicle Med J. 2012; 3: 561-6.
5. Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013; 32: 157-87.
6. Korabathina R, Heffernan KS, Paruchuri V, et al. The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv. 2012; 80: 593-600.
7. Lim HS, Gustafsson F. Pulmonary artery pulsatility index: physiological basis and clinical application. Eur J Heart Fail. 2020; 22: 32-8.
8. Kang G, Ha R, Banerjee D. Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation. J Heart Lung Transplant. 2016; 35: 67–73.

9. Morine KJ, Kiernan MS, Pham DT, Paruchun V, Denofrio D, Kapur NK. Pulmonary artery pulsatility index is associated with right ventricular failure after left ventricular assist device surgery. J Card Fail. 2016; 22: 110–6.
10. Kochav SM, Flores RJ, Truby LK, Topkara VK. Prognostic impact of pulmonary artery pulsatility index (PAPi) in patients with advanced heart failure: insights from the ESCAPE trial. J Card Fail. 2018; 24:453–9.
11. Mazimba S, Welch TS, Mwansa H, et al. Haemodynamically derived pulmonary artery pulsatility index predicts mortality in pulmonary arterial hypertension. Heart Lung Circ. 2019; 28: 752–60.
12. Kukucka M, Stepanenko A, Potapov E, et al. Right-to-left ventricular end-diastolic diameter ratio and prediction of right ventricular failure with continuous-flow left ventricular assist devices. J Heart Lung Transplant. 2011; 30: 64–9.
13. Kato TS, Farr M, Schulze PC, et al Usefulness of two-dimensional echocardiographic parameters of the left side of the heart to predict right ventricular failure after left ventricular assist device implantation. Am J Cardiol. 2012; 109: 246–51.
14. Gronlykke L, Ihlemann N, Ngo AT, et al. Measures of right ventricular function after transcatheter versus surgical aortic valve replacement. Interact Cardiovasc Thorac Surg. 2017; 24: 181–7.
15. Gudejko MD, Gebhardt BR, Zahedi F, et al. Intraoperative hemodynamic and echocardiographic measurements associated with severe right ventricular failure after left ventricular assist device implantation. Anesth Analg. 2019; 128: 25–32.
16. Cesini S, Bhagra S, Pettit SJ. Low Pulmonary Artery Pulsatility Index Is Associated With Adverse Outcomes in Ambulatory Patients With Advanced Heart Failure. J Card Fail. 2020; 26: 352‐9.
17. Lala A, Guo Y, Xu JF, et al. Right ventricular dysfunction in acute myocardial infarction complicated by cardiogenic shock: a hemodynamic analysis of the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial and registry. J Card Fail. 2018; 24: 148–56.
18. Rong LQ, Rahouma M, Neuburger PJ, et al. Use of Pulmonary Artery Pulsatility Index in Cardiac Surgery. J Cardiothorac Vasc Anesth. 2019 Sep 27. pii: S1053- 0770(19)30984-X. doi: 10.1053/j.jvca.2019.09.023. (Epub ahead of print]
19. Guven G, Brankovic M, Constantinescu AA, et al. Preoperative right heart hemodynamics predict postoperative acute kidney injury after heart transplantation. Intensive Care Med. 2018; 44: 588–97.
20. Pellicori P, Zhang J, Cuthbert J, et al. High-sensitivity C-reactive protein in chronic heart failure: patient characteristics, phenotypes, and mode of death. Cardiovasc Res. 2020; 116: 91-100.

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Ali Doğan ^* This is me
Türkiye

Publication Date

June 17, 2020

Submission Date

March 31, 2020

Acceptance Date

June 16, 2020

Published in Issue

Year 2020 Volume: 47 Number: 2

DOI

https://doi.org/10.5798/dicletip.755709

IZ

https://izlik.org/JA73AH74UH

Cite

RIS / Bibtex

APA

Doğan, A. (2020). Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure? Dicle Medical Journal, 47(2), 304-311. https://doi.org/10.5798/dicletip.755709

AMA

1.Doğan A. Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure? Dicle Medical Journal. 2020;47(2):304-311. doi:10.5798/dicletip.755709

Chicago

Doğan, Ali. 2020. “Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?”. Dicle Medical Journal 47 (2): 304-11. https://doi.org/10.5798/dicletip.755709.

EndNote

Doğan A (June 1, 2020) Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure? Dicle Medical Journal 47 2 304–311.

IEEE

[1]A. Doğan, “Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?”, Dicle Medical Journal, vol. 47, no. 2, pp. 304–311, June 2020, doi: 10.5798/dicletip.755709.

ISNAD

Doğan, Ali. “Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?”. Dicle Medical Journal 47/2 (June 1, 2020): 304-311. https://doi.org/10.5798/dicletip.755709.

JAMA

1.Doğan A. Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure? Dicle Medical Journal. 2020;47:304–311.

MLA

Doğan, Ali. “Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?”. Dicle Medical Journal, vol. 47, no. 2, June 2020, pp. 304-11, doi:10.5798/dicletip.755709.

Vancouver

1.Ali Doğan. Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure? Dicle Medical Journal. 2020 Jun. 1;47(2):304-11. doi:10.5798/dicletip.755709