Key result
Lower pulmonary artery pulsatility index was associated with a higher hazard of dialysis in patients with acute decompensated heart failure (HR 1.44; 95% CI 1.06-1.96 per halving).
Why the study?
Patients admitted with acute decompensated heart failure are vulnerable to declines in kidney function, but the exact mechanisms remain unknown.
Are pulmonary artery pulsatility index (PAPI) and aortic pulsatility index (API) associated with kidney outcomes in patients with acute decompensated heart failure?
Cohort (n=753)
No
Are pulmonary artery pulsatility index (PAPI) and aortic pulsatility index (API) associated with kidney outcomes in patients with acute decompensated heart failure?
In patients with acute decompensated heart failure, a lower pulmonary artery pulsatility index (PAPI) is a significant predictor of worsening kidney function and future need for dialysis, whereas aortic pulsatility index (API) is not.
May stratify dialysis risk via PAPI in ADHF; extends cardiorenal hemodynamic markers but leaves open prospective utility.
Key Points Lower pulmonary artery pulsatility index is associated with increased risk of dialysis in patients with heart failure. No association was demonstrated between aortic pulsatility index and kidney outcomes. Background Patients admitted with acute decompensated heart failure are vulnerable to declines in kidney function, but the exact mechanisms are unknown. Two novel hemodynamic markers, pulmonary artery pulsatility index (PAPI) and aortic pulsatility index (API), represent composite right and left ventricular function, respectively. Methods Consecutive unique patient admissions for acute decompensated heart failure to a single quaternary medical center with placement of a pulmonary artery catheter between 2015 and 2021 were reviewed. Cubic spline and linear regression models were used to examine the association between these markers with baseline eGFR and in-hospital eGFR slope. Multivariate Cox proportional hazards models were used to examine the association between PAPI and API with the need for dialysis by linkage of a national database. Covariates included demographics, comorbid conditions, home medications, and baseline eGFR. Results The cohort included N =753 patients with mean (SD) age of 62.2 (14.4) years and eGFR of 58.0 (27.1) ml/min per 1.73 m 2 . For every halving of PAPI, there was a 3.3 (95% confidence interval [CI], 1.5 to 5.1) ml/min per 1.73 m 2 lower baseline eGFR and a 0.78 (95% CI, 0.32 to 1.25) ml/min per 1.73 m 2 per week lower in-hospital eGFR slope. Over a median follow-up time of 30.3 months, lower PAPI was associated with higher hazard of dialysis during the follow-up period (hazard ratio, 1.44 [95% CI, 1.06 to 1.96] per halving). There was no association between API with baseline eGFR, in-hospital eGFR slope, or dialysis. Conclusions Lower PAPI was associated with a lower baseline eGFR, lower in-hospital eGFR slope, and higher risk of dialysis. API was not associated with any kidney outcomes.
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Tuttle et al. (2025) conducted a cohort in Acute decompensated heart failure (n=753). Pulmonary artery pulsatility index (PAPI) was evaluated on Need for dialysis (HR 1.44, 95% CI 1.06 to 1.96). Lower pulmonary artery pulsatility index was associated with a higher hazard of dialysis in patients with acute decompensated heart failure (HR 1.44; 95% CI 1.06-1.96 per halving).
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