TY - JOUR
T1 - Systemic arterial pulsatility index (SAPi) predicts adverse outcomes in advanced heart failure patients
AU - Mazimba, Sula
AU - Mwansa, Hunter
AU - Breathett, Khadijah
AU - Strickling, Jarred E.
AU - Shah, Kajal
AU - McNamara, Coleen
AU - Mehta, Nishaki
AU - Kwon, Younghoon
AU - Lamp, Josephine
AU - Feng, Lu
AU - Tallaj, Jose
AU - Pamboukian, Salpy
AU - Mubanga, Mwenya
AU - Matharoo, Jashanjeet
AU - Lim, Scott
AU - Salerno, Michael
AU - Mwansa, Victor
AU - Bilchick, Kenneth C.
N1 - Publisher Copyright:
© 2022, Springer Japan KK, part of Springer Nature.
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
KW - Heart failure
KW - Heart failure outcomes
KW - SAPi
KW - Ventriculo–arterial coupling
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U2 - 10.1007/s00380-022-02070-7
DO - 10.1007/s00380-022-02070-7
M3 - Article
C2 - 35534640
AN - SCOPUS:85129746021
SN - 0910-8327
VL - 37
SP - 1719
EP - 1727
JO - Heart and Vessels
JF - Heart and Vessels
IS - 10
ER -