Association of Pulmonary Artery Pulsatility Index With Adverse Cardiovascular Events Across a Hospital-Based Sample

Zern, Emily K.; Wang, Dongyu; Rambarat, Paula; Bernard, Samuel; Paniagua, Samantha M.; Liu, Elizabeth; McNeill, Jenna; Wang, Jessica K.; Andrews, Carl T.; Pomerantsev, Eugene; Picard, Michael H.; Ho, Jennifer E.

doi:10.1161/circheartfailure.121.009085

Cited by 26 publications

(25 citation statements)

References 33 publications

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“…Low PAPi has previously been shown to be associated with higher mortality in select samples including post-myocardial infarction, pulmonary arterial hypertension, and advanced heart failure populations [12-17]. We recently demonstrated that lower PAPi was associated with increased risk of adverse events including all-cause mortality, MACE, and HF hospitalizations across a much wider spectrum of cardiopulmonary disease [18]. Similarly, RA:PCWP ratio as an index for RV function has also been demonstrated as a marker for in-hospital mortality [19].…”

Section: Discussionmentioning

confidence: 99%

Obesity Modifies Clinical Outcomes of Right Ventricular Dysfunction

Janet

Zern

Jiang

et al. 2023

Preprint

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Introduction: Right ventricular (RV) dysfunction is associated with increased mortality across a spectrum of cardiovascular diseases. The role of obesity in RV dysfunction and adverse outcomes is unclear. Methods: We examined patients undergoing right heart catheterization between 2005-2016 in a hospital-based cohort. Linear regression was used to examine the association of obesity with hemodynamic indices of RV dysfunction [pulmonary artery pulsatility index (PAPi), right atrial pressure: pulmonary capillary wedge pressure ratio (RAP:PCWP), RV stroke work index (RVSWI)]. Cox models were used to examine the association of RV function measures with clinical outcomes. Results: Among 8285 patients (mean age 63 years, 40% women), higher BMI was associated with worse indices of RV dysfunction, including lower PAPi (β -0.26, SE 0.01, p <0.001), higher RA:PCWP ratio (β 0.25, SE 0.01, p-value <0.001), and lower RVSWI (β -0.05, SE 0.01, p-value <0.001). Over 7.3 years of follow-up, we observed 3006 mortality and 2004 heart failure (HF) hospitalization events. RV dysfunction was associated with greater risk of mortality (eg PAPi: HR 1.11 per 1-SD increase, 95% CI 1.04-1.18), with similar associations with risk of HF hospitalization. BMI modified the effect of RV dysfunction on outcomes (P-interaction <=0.005 for both), such that the effect of RV dysfunction was more pronounced at higher BMI. Conclusions: Patients with obesity had worse hemodynamic measured indices of RV function across a broad hospital-based sample. While RV dysfunction was associated with worse clinical outcomes including mortality and HF hospitalization, this association was especially pronounced among individuals with higher BMI.

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Section: Discussionmentioning

confidence: 99%

Obesity Modifies Clinical Outcomes of Right Ventricular Dysfunction

Janet

Zern

Jiang

et al. 2023

Preprint

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“…The diagnosis of RVF is based on the extent of ventricular impairment, using the central venous pressures (CVP), pulmonary capillary wedge pressure (PCWP) [ 13 ], pulmonary-artery-pulse-pressure-to-right-atrial-pressure ratios (PAPi) (

) [ 14 ] and right ventricular stroke work index (RVSWI) (

) [ 15 ] as indicators [ 16 ] ( Figure 1 ).…”

Section: Definition and Classification Of Cardiogenic Shockmentioning

confidence: 99%

Keep the Right in Mind—A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock

Copeland

Fardman

Furer

2023

Life

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Cardiogenic shock (CS) remains a highly lethal condition despite many efforts and new interventions. Patients presenting with a rapid onset of hemodynamic instability and subsequent collapse require prompt and appropriate multimodality treatment. Multiple etiologies can lead to heart failure and subsequent shock. As the case prevalence of heart failure increases worldwide, it is of great importance to explore all manners and protocols of presentation and treatment present. With research primarily focusing on CS due to cardiac left-sided pathology, few assessments of right-sided pathology and the subsequent clinical state and treatment have been conducted. This review aims to present an in-depth assessment of the currently available literature, assessing the pathophysiology, presentation and management of CS patients due to right heart failure.

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“…PAPi < 0.9 is a predictor of RV failure after LV assist device implantation. Although primarily validated in patients with CS following inferior AMI, it may aid in escalating and weaning therapies in HR‐PCI patients 22 …”

Section: Roadmap Towards a High‐risk Percutaneous Coronary Interventi...mentioning

confidence: 99%

“…Generally, SBP > 90 mmHg, MAP > 60 mmHg, CI > 2.2 L/min/m 2 , CPO > 0.6 W, and LVEDP < 15 mmHg are indicators of haemodynamic recovery, facilitating careful weaning from MCS. In patients with Swan–Ganz catheter, PAPi > 0.9 is a predictor of appropriate RV function 22 . A step‐by‐step algorithm for weaning from Impella is shown in Figure and has been described in the Step 3: Percutaneous Coronary Intervention with Impella section.…”

Section: Roadmap Towards a High‐risk Percutaneous Coronary Interventi...mentioning

confidence: 99%

Roadmap towards an institutional Impella programme for high‐risk coronary interventions

et al. 2023

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Coronary artery disease (CAD) and its complications remain the main cause of morbidity and mortality worldwide. Patients with extensive CAD and multiple comorbidities who require complex, high‐risk percutaneous coronary intervention (HR‐PCI) are at risk of haemodynamic instability and may require short‐term mechanical circulatory support (MCS) during the procedure to maintain sufficient perfusion and prevent ischaemia. Impella is a microaxial continuous blood flow pump used for percutaneous support of the left ventricle in patients undergoing HR‐PCI. Data from randomized controlled trials and registries suggested an advantage for Impella devices in patients undergoing HR‐PCI, compared with other types of MCS. As a thorough understanding of the benefits and drawbacks of the Impella technology is crucial for patient outcomes, we provide a technological overview of Impella and share our experiences gathered during the implementation of institutional Impella programmes in Poland as a roadmap of selection and periprocedural care for patients treated with Impella in the setting of HR‐PCI. We propose 10 steps for implementation of an institutional Impella programme for HR‐PCI, including (i) dedicated staff training; (ii) standard operating procedure and troubleshooting algorithms prior to the first intervention; (iii) patient selection by the multidisciplinary Heart Team; (iv) patient preparation using multimodality imaging; (v) procedure planning in terms of large‐bore access, equipment, and complete revascularization; (vi) starting with HR‐PCI support; (vii) starting with femoral artery access in a patient without extensive peripheral artery disease; (viii) multidisciplinary care after the procedure; (ix) haemodynamic and laboratory monitoring to ensure immediate diagnosis of access‐site complications, bleeding, haemolysis, acute kidney injury, and infections; and (x) careful revision of every HR‐PCI case with the team.

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Association of Pulmonary Artery Pulsatility Index With Adverse Cardiovascular Events Across a Hospital-Based Sample

Cited by 26 publications

References 33 publications

Obesity Modifies Clinical Outcomes of Right Ventricular Dysfunction

Obesity Modifies Clinical Outcomes of Right Ventricular Dysfunction

Keep the Right in Mind—A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock

Roadmap towards an institutional Impella programme for high‐risk coronary interventions

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