Key result
A low pulmonary artery pulsatility index was associated with 1-year mortality in PAH patients (AUC 0.64; 95% CI 0.55-0.74), but was not more discriminative than right atrial pressure alone.
Why the study?
Risk stratification is fundamental in PAH management, and PAPi predicts acute RV dysfunction, but its prognostic utility in a diverse multicentre cohort of patients with PAH needed to be tested.
Does the pulmonary artery pulsatility index (PAPi) predict mortality in adult patients with newly diagnosed pulmonary arterial hypertension?
Cohort
Yes
Does the pulmonary artery pulsatility index (PAPi) predict mortality in adult patients with newly diagnosed pulmonary arterial hypertension?
Effect estimate: AUC 0.64 (95% CI 0.55-0.74)
p-value: p=0.02
While PAPi is associated with 1-year mortality in incident pulmonary arterial hypertension, it does not offer superior prognostic discrimination compared to right atrial pressure alone.
Background: Risk stratification is fundamental in the management of pulmonary arterial hypertension (PAH). Pulmonary artery pulsatility index (PAPi), defined as pulmonary arterial pulse pressure divided by right atrial pressure (RAP), is a hemodynamic index shown to predict acute right ventricular (RV) dysfunction in several settings. Our objective was to test the prognostic utility of PAPi in a diverse multicentre cohort of patients with PAH. Methods: A multicentre retrospective cohort study of consecutive adult patients with a new diagnosis of PAH on right heart catheterization between January 2016 and December 2020 was undertaken across 4 major centres in Canada. Hemodynamic data, clinical data, and outcomes were collected. The association of PAPi and other hemodynamic variables with mortality was assessed by receiver-operating characteristic curves and Cox proportional hazards modeling. Results: = 0.02). In a multivariable model including age, sex, body mass index, and functional class, a low PAPi was associated with mortality at 1 year (area under the curveof 0.64 (95% confidence interval 0.55-0.74). However, high RAP (> 8 mm Hg) was similarly predictive of mortality, with an area under the curve of 0.65. Conclusion: PAPi was associated with mortality in a large incident PAH cohort. However, the discriminative value of PAPi was not higher than that of RAP alone.
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Sugarman et al. (2023) conducted a cohort in Pulmonary arterial hypertension. Pulmonary Artery Pulsatility Index (PAPi) was evaluated on Mortality at 1 year (AUC 0.64, 95% CI 0.55-0.74, p=0.02). A low pulmonary artery pulsatility index was associated with 1-year mortality in PAH patients (AUC 0.64; 95% CI 0.55-0.74), but was not more discriminative than right atrial pressure alone.
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