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. 2021 Oct;27(10):1045-1052.
doi: 10.1016/j.cardfail.2021.05.010. Epub 2021 May 25.

Aortic Pulsatility Index: A Novel Hemodynamic Variable for Evaluation of Decompensated Heart Failure

Mark N Belkin  1 , Sara Kalantari  1 , Anthony J Kanelidis  1 , Tamari Miller  1 , Bryan A Smith  1 , Stephanie A Besser  1 , David Tehrani  2 , Ben B Chung  1 , Ann Nguyen  1 , Nitasha Sarswat  1 , John E A Blair  1 , Daniel Burkhoff  3 , Gabriel Sayer  4 , Sean P Pinney  1 , Nir Uriel  4 , Gene Kim  1 , Jonathan Grinstein  5
Affiliations

Aortic Pulsatility Index: A Novel Hemodynamic Variable for Evaluation of Decompensated Heart Failure

Mark N Belkin et al. J Card Fail. 2021 Oct.

Abstract

Background: Right heart catheterization for invasive hemodynamics has shown only modest correlation with clinical outcomes. We designed a novel hemodynamic variable that incorporates ventricular output and filling pressure. We anticipated that the aortic pulsatility index (API) would correlate with clinical outcomes in patients with heart failure.

Methods and results: We retrospectively analyzed consecutive patients undergoing right heart catheterization with milrinone drug study at our institution (February 2013 to November 2019). The API was calculated as (systolic blood pressure - diastolic blood pressure)/pulmonary capillary wedge pressure. The primary outcome was freedom from advanced therapies, defined as the need for inotropes, temporary mechanical circulatory support, a left ventricular assist device, or orthotopic heart transplantation, or death at 30 days. A total of 224 patient encounters, age 57 years (48-66 years; 34% women; 31% ischemic cardiomyopathy) were included. In univariable analysis, lower baseline API was significantly associated with progression to advanced therapies or death at 30-days (odds ratio 0.43, 95% confidence interval 0.30-0.61; P < .001) compared with those on continued medical management. Receiver operator characteristic analysis specified an optimal cutpoint of 1.45 for API. A Kaplan-Meier analysis indicated an association of API with the primary outcome (79% for API ≥ 1.45 vs 48% for API < 1.45). In multivariable analysis, higher API was strongly associated with freedom from advanced therapies or death (odds ratio 0.38, 95% confidence interval 0.22-0.65, P ≤ .001), even when adjusted for baseline characteristics and routine right heart catheterization measurements.

Conclusions: The API is a novel invasive hemodynamic measurement that is associated independently with freedom from advanced therapies or death at 30-day follow-up.

Keywords: Heart failure; cardiogenic shock; hemodynamics; outcomes.

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Conflict of interest statement

Disclosures

The authors disclose no conflicts.

Figures

Fig. 1.
Fig. 1.
ROC analyses of the primary outcome.
Fig. 2.
Fig. 2.
Kaplan–Meier analysis of API on the freedom from advanced therapies or death at 30 days
See this image and copyright information in PMC

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References

    1. Thakkar AB, Desai SP. Swan, Ganz, and their catheter: its evolution over the past half century. Ann Intern Med 2018;169:636–42. - PubMed
    1. Saxena A, Garan AR, Kapur NK, O’Neill WW, Lindenfeld J, Pinney SP, et al. Value of hemodynamic monitoring in patients with cardiogenic shock undergoing mechanical circulatory support. Circulation 2020;141:1184–97. - PubMed
    1. Taylor SH, Silke B. Is the measurement of cardiac output useful in clinical practice? Br J Anaesth 1988;60(Suppl 1):90S–8S. - PubMed
    1. Opotowsky AR, Hess E, Maron BA, Brittain EL, Baron AE, Maddox TM, et al. Thermodilution vs estimated Fick cardiac output measurement in clinical practice: an analysis of mortality from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (VA CART) program and Vanderbilt University. JAMA Cardiol 2017;2:1090–9. - PMC - PubMed
    1. Cooper LB, Mentz RJ, Stevens SR, Felker GM, Lombardi C, Metra M, et al. Hemodynamic predictors of heart failure morbidity and mortality: fluid or flow? J Card Fail 2016;22:182–9. - PMC - PubMed