Prognostic Value of Periprocedural Pulmonary Artery Pulsatility Index in Patients After Transcatheter Aortic Valve Replacement

The pulmonary artery pulsatility index (PAPi) is a hemodynamic index that reflects right ventricular function. However, the association between PAPi and prognosis in patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to determine how periprocedural changes in the PAPi are associated with patients' prognosis after TAVR. Of the 405 consecutive patients who underwent TAVR for severe aortic stenosis at Hiroshima University Hospital, those with available periprocedural right heart catheter data were included in this study. Patients were divided into 2 groups with a cutoff PAPi value of 3.11 post-TAVR determined by the receiver-operating characteristic curve for the primary endpoint. The primary endpoint was the composite of all-cause mortality and hospitalization caused by heart failure. The secondary endpoint was all-cause mortality. Additionally, factors in the nonimproved PAPi group were investigated. This study enrolled 238 patients. The median follow-up was 405.5 days (Q1-Q3: 353-861 days). A lower PAPi was associated with an increased risk of the primary endpoint (23.3% vs 9.9%; log-rank P < 0.001). After multivariate Cox proportional hazard analysis, post-TAVR PAPi >3.11 was still predictive factor for the primary endpoint (HR: 3.04; 95% CI: 1.30-7.13; P = 0.011). Furthermore, the secondary endpoint was significantly increased in lower PAPi group (log-rank P = 0.010). A nonimproved PAPi predictor was pre-TAVR aortic valve mean pressure gradient in multivariate analysis (OR: 1.02; 95% CI: 1.01-1.04; P = 0.003). The post-TAVR PAPi was associated with all-cause mortality and heart failure hospitalization.