Intraoperative Hemodynamic and Echocardiographic Measurements Associated With Severe Right Ventricular Failure After Left Ventricular Assist Device Implantation

Gudejko, Michael D.; Gebhardt, B; Zahedi, Farhad; Jain, Ankit; Breeze, Janis L.; Lawrence, Matthew; Shernan, Stanton K.; Kapur, Navin K.; Kiernan, Michael S.; Couper, G.S.; Cobey, Frederick C.

doi:10.1213/ane.0000000000003538

Cited by 40 publications

(30 citation statements)

References 33 publications

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“… 7 After left ventricular assist device implantation, a PAPi cut‐off of 1.85 to 2.0 identified right heart failure. 8 , 9 , 10 , 11 Additional haemodynamic studies have shown that a lower PAPi portends increased RV filling pressures and impaired RV to pulmonary artery coupling. 16 In our PAH population, the established cut‐off value PAPi < 5.3 is much higher than in other disease populations, and pales in performance as a risk predictor (AUC 0.612 in PAH vs. 0.998 in RV infarction).…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown to predict RV failure in patients with acute inferior myocardial infarction 7 and after left ventricular assist device implantation. [8][9][10][11] Pulmonary artery pulsatility index as a risk predictor in PAH has also been investigated in a cohort comprising only idiopathic, familial, and anorexigen-associated aetiologies and found to be significantly associated with mortality. The main limitations of this study were narrow inclusion criteria, lack of echocardiographic correlates, and lack of contemporaneous data; data utilized for haemodynamic analysis was referenced from the National Institutes of Health Registry for Primary Pulmonary Hypertension, which was published in the 1980s.…”

Section: Introductionmentioning

confidence: 99%

“…It has been shown to predict RV failure in patients with acute inferior myocardial infarction 7 and after left ventricular assist device implantation. 8 , 9 , 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

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Does pulmonary artery pulsatility index predict mortality in pulmonary arterial hypertension?

et al. 2021

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Aims Pulmonary artery pulsatility index (PAPi), defined as [(pulmonary artery systolic pressure À diastolic pulmonary artery pressure)/mean right atrial pressure], is a novel haemodynamic index that predicts right ventricular failure after myocardial infarction and left ventricular assist device implantation. We analysed if a low PAPi is associated with death in our 14 -year pulmonary arterial hypertension (PAH) registry. Methods Consecutive patients with newly diagnosed PAH and complete haemodynamic data were prospectively enrolled into our standing registry between January 2003 and December 2016. PAPi was calculated from baseline invasive right heart catheterization data. A prognostic cut-off value was determined with a decision tree. Baseline characteristics of 'high' and 'low' PAPi groups based on this cut-off were compared, as well as odds of death and time-to-death. Results One hundred and two patients were included. Mean age was 53 years, and 77% were women. Our multi-ethnic cohort was 64% Chinese, 23% Malay, and 10% Indian. The aetiologies were idiopathic (33%), connective tissue disease (31%), congenital heart disease (24%), and others (12%). The low PAPi group (<5.3) had a greater age (56 years vs. 49 years), lower pulmonary artery systolic pressure (71 mmHg vs. 85 mmHg), and higher mean right atrial pressure (14 mmHg vs. 6 mmHg). Mortality risk was higher in the low PAPi group (adjusted odds ratio: 2.98 and adjusted hazard ratio: 2.23). Mean right atrial pressure was the strongest predictor (hazard ratio 1.114, P = 0.009) when components of PAPi were analysed. Conclusions Pulmonary artery pulsatility index was found to be predictive of mortality in PAH and may be a valuable marker for risk stratification. Its prognostic strength may be driven by mean right atrial pressure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does pulmonary artery pulsatility index predict mortality in pulmonary arterial hypertension?

et al. 2021

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“…Right heart failure is a major cause of morbidity and mortality in patients undergoing left ventricular assist device implantation. PAPi has been evaluated pre‐operatively and intra‐operatively to predict the development of RHF in patients with left ventricular assist devices. The mean PAPi in patients who developed RHF after left ventricular assist device implant ranged from 1.3 ± 0.5 to 1.7 ± 0.3 and a PAPi threshold of 1.85 to identify patients at high risk of RHF has been proposed .…”

Section: Pulmonary Artery Pulsatility Indexmentioning

confidence: 99%

Pulmonary artery pulsatility index: physiological basis and clinical application

Lim

Gustafsson

2019

European J of Heart Fail

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Pulmonary artery pulsatility index (PAPi) is a haemodynamic parameter that is derived from right atrial and pulmonary artery pulse pressures. A number of reports have described the prognostic value of PAPi in patients with advanced heart failure and cardiogenic shock. However, the derivation and physiological interpretation of this parameter have received little attention. This review will examine the physiological interpretation and clinical data for PAPi.

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“…Since its first application in RV myocardial infarction, different patient groups were investigated. Apart from preoperative evaluation of LVAD planned patients, it was also examined intraoperatively during LVAD implantation 15 .…”

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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Intraoperative Hemodynamic and Echocardiographic Measurements Associated With Severe Right Ventricular Failure After Left Ventricular Assist Device Implantation

Abstract: Post-chest closure values of CVP and PAPi were significantly associated with severe RVF. Echocardiographic assessment of RV function post-CPB was weakly associated with severe RVF.

Cited by 40 publications

References 33 publications

Does pulmonary artery pulsatility index predict mortality in pulmonary arterial hypertension?

Does pulmonary artery pulsatility index predict mortality in pulmonary arterial hypertension?

Pulmonary artery pulsatility index: physiological basis and clinical application

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

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