Use of Pulmonary Artery Pulsatility Index in Cardiac Surgery

Rong, Lisa Q.; Rahouma, Mohamed; Neuburger, Peter J.; Arguelles, Gabriel R; Emerson, Jacqueline M.; Tam, Christopher W.; Shore‐Lesserson, Linda; Pryor, Kane O.; Gaudino, Mario

doi:10.1053/j.jvca.2019.09.023

Cited by 16 publications

(27 citation statements)

References 22 publications

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“…To date, there has been no determination of a normal PAPi range. In prior studies, receiver operating characteristic curves have demonstrated an optimal PAPi cutoff of <1.85-2 for RV failure after left ventricular assist device implantation, 14,15 <1.9 for RV dysfunction after cardiac surgery, 18 <3.65 for mortality or hospitalization in the advanced HF population, 20 and <1 for in-hospital mortality or requirement for percutaneous RV support device after inferior MI. 13 In pulmonary arterial hypertension and ambulatory patients with HF, only the lowest PAPi quartile patients (PAPi <3.7 and 1.4, respectively) were found to have adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

Zern

Wang

Rambarat

et al. 2022

Circ: Heart Failure

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Background: 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. Whether PAPi is associated with adverse outcomes across a heterogeneous population is unknown. Methods: We examined consecutive patients undergoing right heart catheterization between 2005 and 2016 in a hospital-based cohort. Multivariable Cox models were utilized to examine the association between PAPi and all-cause mortality, major adverse cardiac events, and heart failure hospitalizations. Results: We studied 8285 individuals (mean age 63 years, 39% women) with median PAPi across quartiles 1.7, 2.8, 4.2, and 8.7, who were followed over a mean follow-up of 6.7±3.3 years. Patients in the lowest PAPi quartile had a 60% greater risk of death compared with the highest quartile (multivariable-adjusted hazard ratio, 1.60 [95% CI, 1.36–1.88], P <0.001) and a higher risk of major adverse cardiac events and heart failure hospitalizations (hazard ratio, 1.80 [95% CI, 1.56–2.07], P <0.001 and hazard ratio, 2.08 [95% CI, 1.76–2.47], P <0.001, respectively). Of note, patients in quartiles 2 and 3 also had increased risk of cardiovascular events compared with quartile 4 (multivariable P <0.05 for all). Conclusions: 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. 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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Section: Discussionmentioning

confidence: 99%

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

Zern

Wang

Rambarat

et al. 2022

Circ: Heart Failure

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“…Deterioration of right heart following cardiac surgery is related with mortality and morbidity. Rong et al studied this topic and indicated preoperative PAPi was a predictor of postoperative RV dysfunction 18 . Moreover, after heart transplantation, lower PAPi was found to related with acute kidney injury 19 .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?

Doğan¹

2020

Dicle Tıp Dergisi

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The effect of pulmonary artery pulsatility index (PAPi) on mortality in patients with advanced chronic heart failure (HF). Methods:The study included 53 patients with advanced chronic HF, with ejection fraction below 30%, who underwent right and left catheterization. Two groups were formed according to the development of cardiac mortality. Results:Of 53 patients in the study group, 18 patients developed cardiac mortality (33.9%). While male gender and peripheral artery disease were more in the cardiac mortality group, CRP level was also seen more in this group. As stroke volume, aortic pressures, left ventricular systolic pressure were lower in the cardiac mortality group, right atrium pressure (RAP) was higher. PAPi was associated with cardiac mortality and lower in this group (P = 0.001). According to univariate analysis, PAPi and RAP were among predictors of cardiac mortality. However, multivariate analysis indicated that only RAP was an independent predictor. PAPi threshold value for cardiac mortality was calculated as 2.9 (88.9% sensitivity and 74.3% specificity). Conclusion:PAPi is related with cardiac mortality in advanced HF. However, it is not an independent predictor. PAPi is mostly dependent on right atrial pressure.

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“…3 Although the role of preoperative PAPi has been investigated in the heart failure and left ventricular assist device population, it has not been evaluated in patients undergoing routine cardiac surgery and thus no meaningful comparison could be made. 22 To date, one small, single-centre study (N=119) evaluated the role of prebypass-and postbypass PAPi in early identification of cardiac surgery-related RVF, 6 but the AUC of preoperative PAPi was not reported. Our findings suggest that IGFBP7 could be further evaluated as a non-invasive screening tool to identify cardiac surgery patients who are at risk for developing perioperative RVF.…”

Section: Right Ventricular Failurementioning

confidence: 99%

“…3 6 Both haemodynamic markers are load-dependent, with limited evidence to support their routine clinical use. 6 Given the limitations of haemodynamic markers and the nonspecific nature of NT-pro-BNP, investigations have turned to the discovery of RVF-specific biomarkers to improve clinical…”

Section: Introductionmentioning

confidence: 99%

“…The utility of NT-pro-BNP has also been investigated in association with RVF and found to perform modestly at best in the perioperative setting 2 5. Aside from biomarkers, the central venous pressure (CVP) and Pulmonary Artery Pulsatility Index (PAPi) are two haemodynamic markers with moderate ability to predict postoperative RVF and c-AKI 3 6. Both haemodynamic markers are load-dependent, with limited evidence to support their routine clinical use 6.…”

Section: Introductionmentioning

confidence: 99%

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IGFBP7 as a preoperative predictor of congestive acute kidney injury after cardiac surgery

2022

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ObjectiveCongestive acute kidney injury (c-AKI) refers to AKI in the presence of right ventricular failure (RVF) and is a highly morbid complication of cardiac surgery. However, treatment has traditionally been reactive rather than proactive due to limited modalities to predict this complication. The objective of this study was to investigate the ability of insulin-like growth-factor binding protein 7 (IGFBP7), to predict c-AKI, AKI and RVF in patients undergoing cardiac surgery, as compared to N-terminal prohormone B-type natriuretic peptide (NT-pro-BNP) and pulmonary artery pulsatility index (PAPi).MethodsThis prospective nested case–control study consisted of 350 adult patients who underwent elective cardiac surgery. The outcomes were c-AKI, AKI and RVF. Unadjusted and adjusted conditional logistic regression models and areas under the receiver operating characteristic curve (AUC) were used to assess the predictive performance of each marker.ResultsFor the prediction of c-AKI, the unadjusted IGPBP7 model had an AUC of 0.81, as compared with 0.51 for NT-pro-BNP and 0.61 for PAPi. The adjusted c-AKI models had AUCs of 0.90 for IGFBP7, 0.87 for NT-pro-BNP and 0.77 for PAPi. For AKI and RVF, the predictive performance of IGFBP7 was moderate and exceeded that of NT-pro-BNP and PAPi in univariable analysis. IGFBP7 remained a robust independent predictor of all outcomes in multivariable analysis, whereas the other markers did not.ConclusionsIGFBP7 is a promising biomarker for prediction of AKI, RVF and c-AKI and could have value for preoperative optimisation and risk stratification of patients undergoing cardiac surgery.

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Use of Pulmonary Artery Pulsatility Index in Cardiac Surgery

Cited by 16 publications

References 22 publications

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

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

Pulmonary Artery Pulsatility Index As A Predictor Of Cardiac Mortality In Advanced Chronic Heart Failure: Is It Beyond Right Atrial Pressure?

IGFBP7 as a preoperative predictor of congestive acute kidney injury after cardiac surgery

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