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. 2019 May;28(5):752-760.
doi: 10.1016/j.hlc.2018.04.280. Epub 2018 Apr 17.

Haemodynamically Derived Pulmonary Artery Pulsatility Index Predicts Mortality in Pulmonary Arterial Hypertension

Sula Mazimba  1 , Timothy S Welch  2 , Hunter Mwansa  3 , Khadijah K Breathett  4 , Jamie L W Kennedy  2 , Andrew D Mihalek  2 , William C Harding  5 , Manu M Mysore  5 , David X Zhuo  5 , Kenneth C Bilchick  2
Affiliations

Haemodynamically Derived Pulmonary Artery Pulsatility Index Predicts Mortality in Pulmonary Arterial Hypertension

Sula Mazimba et al. Heart Lung Circ. 2019 May.

Abstract

Background: Pulmonary artery (PA) pulsitility index (PAPi) is a novel haemodynamic index shown to predict right ventricular failure in acute inferior myocardial infarction and post left ventricular assist device surgery. We hypothesised that PAPi calculated as [PA systolic pressure - PA diastolic pressure]/right atrial pressure (RAP) would be associated with mortality in the National Institutes of Health Registry for Primary Pulmonary Hypertension (NIH-RPPH).

Methods: The impact of PAPi, the Pulmonary Hypertension Connection (PHC) risk score, right ventricular stroke work, pulmonary artery capacitance (PAC), other haemodynamic indices, and demographic characteristics was evaluated in 272 NIH-RPPH patients using multivariable Cox proportional hazards (CPH) regression and receiver operating characteristic (ROC) analysis.

Results: In the 272 patients (median age 37.7+/-15.9years, 63% female), the median PAPi was 5.8 (IQR 3.7-9.2). During 5years of follow-up, 51.8% of the patients died. Survival was markedly lower (32.8% during the first 3years) in PAPi quartile 1 compared with the remaining patients (58.5% over 3years in quartiles 2-4; p<0.0001). The best multivariable CPH survival model included PAPi, the PHC-Risk score, PAC, and body mass index (BMI). In this model, the adjusted hazard ratio for death with increasing PAPi was 0.946 (95% CI 0.905-0.989). The independent ROC areas for 5-year survival based on bivariable logistic regression for PAPi, BMI, PHC Risk, and PAC were 0.63, 0.62, 0.64, and 0.65, respectively (p<0.01). The ROC area for 5-year survival for the multivariable logistic model with all four covariates was 0.77 (p<0.0001).

Conclusions: Pulmonary artery pulsatility index was independently associated with survival in PAH, highlighting the utility of PAPi in combination with other key measures for risk stratification in this population.

Keywords: Heart failure; PAPi; Pulmonary hypertension.

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Figures

Figure 1:
Figure 1:. Histograms of (A) PAPi Distribution.
The histogram showing the distribution of the pulmonary artery pulsatility index (PAPi).
Figure 2:
Figure 2:. Kaplan Meier Survival Curves for the Quartiles of PAPi.
Kaplan Meier survival curves are shown by quartiles of PAPi.
Figure 3:
Figure 3:. Kaplan Meier Survival Curves for PAPi.
Kaplan Meier survival curves comparing PAPi in the lowest quartile versus remaining patients are shown.
Figure 4:
Figure 4:. ROC Analysis for Pulmonary Artery Pulsatility Indices.
Receiver Operating Characteristic (ROC) curves are shown for the multivariable logistic regression model for 5-year survival with the Pulmonary artery pulsatility index (A), BMI (B), PAC (C), the PHC risk equation (D), and all four variables together (E).
See this image and copyright information in PMC

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