Low Aortic Pulsatility Index and Pulmonary Artery Pulsatility Index Are Associated With Increased Mortality in Patients With Dilated Cardiomyopathy Awaiting Heart Transplantation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Advanced dilated cardiomyopathy (DCM) (n=120). Intervention: Continuous aortic pulsatility index (API) vs. Lower API. Primary outcome: All-cause mortality within 1 year after right heart catheterization (Adjusted HR 0.396, 95% CI 0.232-0.673, p=0.001).

Q: What does this research mean for the field?

Higher aortic pulsatility index and pulmonary artery pulsatility index are independently associated with reduced mortality and refine risk stratification in patients with advanced dilated cardiomyopathy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yihang Wu; Yuhui Zhang; Jian Zhang

doi:10.4070/kcj.2024.0192

October 22, 2024Sunhwan'giOpen Access

Low Aortic Pulsatility Index and Pulmonary Artery Pulsatility Index Are Associated With Increased Mortality in Patients With Dilated Cardiomyopathy Awaiting Heart Transplantation

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Key result

Higher aortic pulsatility index is linked to ~60% lower 1-year mortality in advanced dilated cardiomyopathy.

Adjusted HR 0.396
95% CI 0.232-0.673
P=0.001
n=120

Figures

Graphical abstract published by Sunhwan'gi — Graphical abstract · Published by Sunhwan'gi · CC BY-NC

Why the study?

Patients with dilated cardiomyopathy often have biventricular impairment, and researchers hypothesized that combining the aortic pulsatility index and pulmonary artery pulsatility index could refine risk stratification.

Does a lower aortic pulsatility index (API) and pulmonary artery pulsatility index (PAPI) predict increased mortality in patients with advanced dilated cardiomyopathy awaiting heart transplantation?

Study Design

Type

Cohort (n=120)

Multicenter

No

Structured PICO

Does a lower aortic pulsatility index (API) and pulmonary artery pulsatility index (PAPI) predict increased mortality in patients with advanced dilated cardiomyopathy awaiting heart transplantation?

P

Population

120 adult patients with advanced dilated cardiomyopathy undergoing right heart catheterization and awaiting heart transplantation, followed for a median of 102 days.

E

Exposure

Aortic pulsatility index (API) and pulmonary artery pulsatility index (PAPI) measured via right heart catheterization

C

Comparator

Lower versus higher API/PAPI values

O

Outcome

All-cause mortality within 1 year after undergoing right heart catheterizationhard clinical

Main Result

Hazard Ratio: 0.396 (95% CI 0.232–0.673)

p-value: p=0.001

The combination of the aortic pulsatility index and the pulmonary artery pulsatility index provides a strong, cardiac-output-independent assessment for predicting mortality in patients with advanced dilated cardiomyopathy.

Limitations

Single-center study with a relatively small number of patients
LVEF and TAPSE were the only two quantitative measures of cardiac function collected, lacking other echocardiographic and cardiac magnetic resonance parameters
Measured at a single point in time, and aggressive treatment during transplant evaluation might have influenced values
Patients enrolled at the HF Care Unit tend to be the most critical, potentially limiting external validity
Single-center study
Small sample size
Lack of additional echocardiographic or CMR biventricular parameters
Aggressive treatment might have influenced measurements
Limited external validity due to critical condition of the cohort

Implication

Higher API was associated with lower mortality; extends pulsatility indices for risk stratification but leaves open prospective validation in advanced dilated cardiomyopathy.

Abstract

Author's summary Dilated cardiomyopathy (DCM) is usually characterized by biventricular involvement. The pulmonary artery pulsatility index (PAPI) is a hemodynamic parameter related to right ventricular function. Aortic pulsatility index (API) is a novel hemodynamic parameter related to left ventricular (LV) function, and its calculation formula is symmetric to PAPI. We described the clinical characteristics of patients with DCM stratified by API and PAPI. Our results demonstrated that 1) API could provide additional prognostic value to LV ejection fraction; 2) PAPI could provide additional prognostic value to tricuspid annular plane systolic excursion; and 3) the combination of API and PAPI could refine risk stratification.

Discussion

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Cite This Study

Wu et al. (2024) conducted a cohort in Advanced dilated cardiomyopathy (DCM) (n=120). Continuous aortic pulsatility index (API) vs. Lower API was evaluated on All-cause mortality within 1 year after right heart catheterization (Adjusted HR 0.396, 95% CI 0.232-0.673, p=0.001). Higher continuous aortic pulsatility index (API) was independently associated with a reduced risk of 1-year all-cause mortality (adjusted HR 0.396) in patients with advanced dilated cardiomyopathy.

synapsesocial.com/papers/6a8c0c2152e1a91077e98d74 https://doi.org/10.4070/kcj.2024.0192

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Low Aortic Pulsatility Index and Pulmonary Artery Pulsatility Index Are Associated With Increased Mortality in Patients With Dilated Cardiomyopathy Awaiting Heart Transplantation

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Low Aortic Pulsatility Index and Pulmonary Artery Pulsatility Index Are Associated With Increased Mortality in Patients With Dilated Cardiomyopathy Awaiting Heart Transplantation

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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