Pulmonary artery pulsatility index was independently associated with survival in PAH, highlighting the utility of PAPi in combination with other key measures for risk stratification in this population.

Background Pulmonary hypertension (PH) is characterized by increased pulmonary vascular resistance leading to right heart failure. Elevated right atrial (RA) pressure reflects right ventricular (RV) pressure overload and is an established risk factor for mortality in PH. We hypothesized that PH patients with an increased ratio of RA to LA volume index (RAVI/LAVI), would have increased mortality. Methods We evaluated the association of RAVI/LAVI with mortality in 124 patients seen at a single academic center's PH clinic after adjusting for the REVEAL risk score, an established risk score in PH. LA and RA volume indices were measured in the four‐and two‐chamber views by two independent researchers. Multivariable logistic regression was used to model the independent association of RAVI/LAVI with survival. Results Among 124 patients (mean age 62 ± 12.7 years, 68.6% female), each unit increase in RAVI/LAVI was associated with a nearly twofold increase in mortality (OR: 1.91, 95% CI: 1.20–3.04). In a multivariable logistic regression, each unit increase in RAVI/LAVI was associated with a nearly twofold increase in mortality (OR: 1.73, 95% CI: 1.003–2.998). Furthermore, RAVI/LAVI in the highest quartile (>1.42) was significantly associated with elevated right atrial pressure (RAP) to pulmonary artery wedge pressure ratio (RAP/PAWP) (0.76 ± 0.41, P = 0.02) compared with the lowest quartile (<0.77), suggesting an interaction between invasive hemodynamic data, atrial structural changes, and mortality in PH. Conclusions Increased RAVI/LAVI in PH is associated with decreased survival and accounts for atrial structural remodeling related to invasive hemodynamics. These findings support further study of this index in predicting outcomes in PH.

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Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder in the USA, and it has been noted to increase cardiovascular risk in addition to its known adverse effects on quality of life (Peppard et al., 2013). A growing body of evidence has linked OSA to the development atrial fibrillation (AF), which is the most common cardiac arrhythmia and associated with significant morbidity and mortality

Background This study evaluated the utility of a novel index, pulmonary arterial (PA) proportional pulse pressure (PAPP; range 0–1, defined as [PA systolic pressure – PA diastolic pressure] / PA systolic pressure), in predicting mortality in patients with World Health Organization group 1 pulmonary hypertension (PH). Hypothesis Low PAPP is associated with increased 5‐year mortality independent of a validated contemporary risk‐prediction equation (Pulmonary Hypertension Connection [PHC] equation). Methods In a group of 262 patients in the National Institutes of Health Primary Pulmonary Hypertension (NIH‐PPH) Registry, PAPP and the PHC risk equation were used to predict mortality during 5 years of follow‐up using Cox proportional hazards models. Kaplan–Meier survival curves were used to compare mortality among PAPP quartiles, and significance was tested using the log‐rank test. Results Patients in the lowest quartile (PAPP ≤0.47) had a significantly higher 5‐year mortality than did patients in higher quartiles (log‐rank P = 0.016). In a Cox model adjusted for the PHC equation, PAPP remained significantly associated with 5‐year mortality (hazard ratio: 0.74 per 0.10 increase in PAPP, 95% confidence interval: 0.61‐0.90). The χ2 statistic for the single PAPP covariate in this model was 8.8 (P = 0.003), which compared favorably with the χ2 statistic of 15.2 (P < 0.0001) for the multivariable PHC equation. Conclusions PAPP, an index of ventricular‐arterial coupling, is independently associated with survival in World Health Organization group 1 PH. The use of this easily measurable index for guiding risk stratification needs further investigation.