. 2023 Apr 25;5(7):545-553.

doi: 10.1016/j.cjco.2023.04.005. eCollection 2023 Jul.

Association Between the Pulmonary Artery Pulsatility Index and Prognosis in Pulmonary Arterial Hypertension: A Multicentre Study

Sam Ostad¹, Jordan Sugarman^{2

3}, Abdullah Alkhodair⁴, Jiaming Liang¹, Lisa M Mielniczuk⁵, Nathan Hambly⁶, Doug Helmersen², Naushad Hirani², Mitesh Thakrar², Rhea Varughese^{7

8}, Monica Norena⁹, Mithum Kularatne², John R Swiston¹⁰, Ali Kapasi¹⁰, Jason Weatherald^{7

8}, Nathan W Brunner⁴

Affiliations

¹ Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
² Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Department of Medicine, Division of Respirology, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Department of Medicine, Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada.
⁸ Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁹ Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
¹⁰ Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 37496788
PMCID: PMC10366663
DOI: 10.1016/j.cjco.2023.04.005

Association Between the Pulmonary Artery Pulsatility Index and Prognosis in Pulmonary Arterial Hypertension: A Multicentre Study

Sam Ostad et al. CJC Open. 2023.

. 2023 Apr 25;5(7):545-553.

doi: 10.1016/j.cjco.2023.04.005. eCollection 2023 Jul.

Authors

Affiliations

¹ Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
² Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Department of Medicine, Division of Respirology, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Department of Medicine, Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada.
⁸ Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁹ Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
¹⁰ Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 37496788
PMCID: PMC10366663
DOI: 10.1016/j.cjco.2023.04.005

Abstract
in English, French

Background: Risk stratification is fundamental in the management of pulmonary arterial hypertension (PAH). Pulmonary artery pulsatility index (PAPi), defined as pulmonary arterial pulse pressure divided by right atrial pressure (RAP), is a hemodynamic index shown to predict acute right ventricular (RV) dysfunction in several settings. Our objective was to test the prognostic utility of PAPi in a diverse multicentre cohort of patients with PAH.

Methods: A multicentre retrospective cohort study of consecutive adult patients with a new diagnosis of PAH on right heart catheterization between January 2016 and December 2020 was undertaken across 4 major centres in Canada. Hemodynamic data, clinical data, and outcomes were collected. The association of PAPi and other hemodynamic variables with mortality was assessed by receiver-operating characteristic curves and Cox proportional hazards modeling.

Results: We identified 590 patients with a mean age of 61.4 ± 15.5 years, with 66.3% being female. A low PAPi (defined as < 5.3) was associated with higher mortality at 1 year: 10.2% vs 5.2% (P = 0.02). In a multivariable model including age, sex, body mass index, and functional class, a low PAPi was associated with mortality at 1 year (area under the curveof 0.64 (95% confidence interval 0.55-0.74). However, high RAP (> 8 mm Hg) was similarly predictive of mortality, with an area under the curve of 0.65.

Conclusion: PAPi was associated with mortality in a large incident PAH cohort. However, the discriminative value of PAPi was not higher than that of RAP alone.

Contexte: La stratification des risques est fondamentale dans la prise en charge de l’hypertension artérielle pulmonaire (HTAP). L’indice de pulsatilité des artères pulmonaires (iPAP), défini comme la pression différentielle dans les artères pulmonaires divisée par la pression auriculaire droite (PAD), est un indice hémodynamique qui s’est révélé prédictif d’une dysfonction ventriculaire droite (VD) aiguë dans plusieurs situations. Notre objectif était d’évaluer l’utilité pronostique de l’iPAP dans une cohorte multicentrique diversifiée de patients atteints d’HTAP.

Méthodologie: Une étude de cohorte multicentrique rétrospective de patients adultes consécutifs atteints d’une HTAP nouvellement diagnostiquée par cathétérisme cardiaque droit entre janvier 2016 et décembre 2020 a été effectuée dans quatre grands centres au Canada. Les données hémodynamiques, les données cliniques et les résultats ont été recueillis. La corrélation de l’iPAP et d’autres va-riables hémodynamiques avec la mortalité a été évaluée par les courbes caractéristiques opérationnelles du receveur et des modèles à risques proportionnels de Cox.

Résultats: Nous avons recensé 590 patients dont l’âge moyen était de 61,4 ± 15,5 ans; la proportion de femmes était de 66,3 %. Un faible iPAP (défini comme une valeur < 5,3) a été associé à une hausse de la mortalité à 1 an : 10,2 % contre 5,2 % (p= 0,02). Dans un modèle multivarié comprenant l’âge, le sexe, l’indice de masse corporelle et la classe fonctionnelle, un faible iPAP a été associé à la mortalité à 1 an (aire sous la courbe de 0,64 [intervalle de confiance à 95 %; de 0,55 à 0,74]). Cependant, une PAD élevée (> 8 mmHg) a aussi été un facteur prédictif de mortalité, l’aire sous la courbe étant de 0,65.

Conclusions: L’iPAP a été associé à la mortalité dans une vaste cohorte de patients atteints d’une HTAP. Toutefois, la valeur discriminante de l’iPAP n’a pas été supérieure à celle de la PAD seule.

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Figures

**Figure 1**
Receiver operating curve (ROC) for (A) PAPi (pulmonary artery pulsatility index), (B) mean right atrial pressure (mRAP), and (C) cardiac index. PAPi is defined as pulmonary arterial pulse pressure divided by right atrial pressure. AUC, area under the curve.

**Figure 2**
Kaplan-Meier curves for (A) pulmonary artery pulsatility index (PAPi) and (B) mean right atrial pressure (mRAP).

See this image and copyright information in PMC

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References

1. Parikh V., Bhardwaj A., Nair A. Pharmacotherapy for pulmonary arterial hypertension. J Thorac Dis. 2019;11(suppl 14):S1767–S1781. - PMC - PubMed
1. Boucly A., Weatherald J., Savale L., et al. External validation of a refined four-stratum risk assessment score from the French pulmonary hypertension registry. Eur Respir J. 2022;59 - PMC - PubMed
1. Zelt J.G.E., Sugarman J., Weatherald J., et al. Mortality trends in pulmonary arterial hypertension in Canada: a temporal analysis of survival per ESC/ERS guideline era. Eur Respir J. 2022;59 - PMC - PubMed
1. Galie N., Channick R.N., Frantz R.P., et al. Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J. 2019;53 - PMC - PubMed
1. Galie N., Humbert M., Vachiery J.L., et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT) Eur Respir J. 2015;46:903–975. - PubMed

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Association Between the Pulmonary Artery Pulsatility Index and Prognosis in Pulmonary Arterial Hypertension: A Multicentre Study

Affiliations

Association Between the Pulmonary Artery Pulsatility Index and Prognosis in Pulmonary Arterial Hypertension: A Multicentre Study

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