PAPi predictor of right ventricular failure after inferior myocardial infarction
The pulmonary artery pulsatility index (PAPi), calculated from the ratio of the pulmonary artery pulse pressure to right atrial pressure, is a predictor of right ventricular failure after inferior myocardial infarction and left ventricular assist device implantation. A recent study suggests that lower PAPi is associated with all-cause mortality, major adverse cardiac events, and heart failure hospitalizations across a large heterogeneous patient sample. The study findings were published online in the journal Circulation: Heart Failure on February 09, 2022.
Although prior studies have focused on specific advanced disease samples, the clinical implications of PAPi across a large diverse sample of individuals with a range of cardiopulmonary diseases remains unclear. Therefore, Dr Emily K. Zern and her team conducted a study to evaluate the association between PAPi and adverse outcomes across a heterogeneous population.
In this study, the researchers examined consecutive patients undergoing right heart catheterization between 2005 and 2016 in a hospital-based cohort. They included 8285 patients with median PAPi across quartiles 1.7, 2.8, 4.2, and 8.7, and followed them over a mean follow-up of 6.7±3.3 years. They used multivariable Cox models to examine the association between PAPi and all-cause mortality, major adverse cardiac events, and heart failure hospitalizations.
Key findings of the study:
♦ Upon analysis, the researchers found that the patients in the lowest PAPi quartile had a
- 60% greater risk of death compared with the highest quartile (multivariable-adjusted hazard ratio, 1.60 )
- Higher risk of major adverse cardiac events (hazard ratio, 1.80) and
- High heart failure hospitalizations (hazard ratio, 2.08)
♦ They also noted that the patients in quartiles 2 and 3 also had an increased risk of cardiovascular events compared with quartile 4.
The authors concluded, "Compared with the highest PAPi quartile, patients in PAPi quartiles 1 to 3 had a greater risk of all-cause mortality, major adverse cardiac events, and heart failure hospitalizations, with greatest risk observed in the lowest quartile."
They further added, "A low PAPi, even at values higher than previously reported, may serve an important role in identifying high-risk individuals across a broad spectrum of cardiovascular disease."
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