Systemic arterial pulsatility index (SAPi) predicts adverse outcomes in advanced heart failure patients

Sula Mazimba, Hunter Mwansa, Khadijah Breathett, Jarred E. Strickling, Kajal Shah, Coleen McNamara, Nishaki Mehta, Younghoon Kwon, Josephine Lamp, Lu Feng, Jose Tallaj, Salpy Pamboukian, Mwenya Mubanga, Jashanjeet Matharoo, Scott Lim, Michael Salerno, Victor Mwansa, Kenneth C. Bilchick

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Ventriculo–arterial (VA) coupling has been shown to have physiologic importance in heart failure (HF). We hypothesized that the systemic arterial pulsatility index (SAPi), a measure that integrates pulse pressure and a proxy for left ventricular end-diastolic pressure, would be associated with adverse outcomes in advanced HF. We evaluated the SAPi ([systemic systolic blood pressure-systemic diastolic blood pressure]/pulmonary artery wedge pressure) obtained from the final hemodynamic measurement in patients randomized to therapy guided by a pulmonary arterial catheter (PAC) and with complete data in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Cox proportional hazards regression was performed for the outcomes of (a) death, transplant, left ventricular assist device (DTxLVAD) or hospitalization, (DTxLVADHF) and (b) DTxLVAD. Among 142 patients (mean age 56.8 ± 13.3 years, 30.3% female), the median SAPi was 2.57 (IQR 1.63–3.45). Increasing SAPi was associated with significant reductions in DTxLVAD (HR 0.60 per unit increase in SAPi, 95% CI 0.44–0.84) and DTxLVADHF (HR 0.81 per unit increase, 95% CI 0.70–0.95). Patients with a SAPi ≤ 2.57 had a marked increase in both outcomes, including more than twice the risk of DTxLVAD (HR 2.19, 95% CI 1.11–4.30) over 6 months. Among advanced heart failure patients with invasive hemodynamic monitoring in the ESCAPE trial, SAPi was strongly associated with adverse clinical outcomes. These findings support further investigation of the SAPi to guide treatment and prognosis in HF undergoing invasive hemodynamic monitoring.

Original languageEnglish (US)
Pages (from-to)1719-1727
Number of pages9
JournalHeart and Vessels
Issue number10
StatePublished - Oct 2022
Externally publishedYes


  • Heart failure
  • Heart failure outcomes
  • SAPi
  • Ventriculo–arterial coupling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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