Aortic Pulsatility Index: A Novel Hemodynamic Variable for Evaluation of Decompensated Heart Failure.

Abstract

BACKGROUND\nRight heart catheterization (RHC) for invasive hemodynamics has shown only modest correlation with clinical outcomes. We designed a novel hemodynamic variable that incorporates ventricular output and filling pressure. We anticipated that aortic pulsatility index (API) would correlate with clinical outcomes in heart failure patients.\n\n\nMETHODS\nWe retrospectively analyzed consecutive patients undergoing RHC with milrinone drug study at our institution (2/2013-11/2019). API was calculated as (systolic blood pressure - diastolic blood pressure)/pulmonary capillary wedge pressure. The primary outcome was freedom from advanced therapies (AT), defined as need for inotropes, temporary mechanical circulatory support, left ventricular assist device, orthotopic heart transplant, or death at 30 days.\n\n\nRESULTS\nA total of 224 patient encounters, age 57 (48-66) years, 34% women 31% ischemic cardiomyopathy) were included. In univariable analysis, lower baseline API was significantly associated with progression to AT or death at 30-days, OR 0.43 (95%CI 0.30-0.61, p<0.001) compared to those on continued medical management. Receiver operator characteristic analysis specified an optimal cut-point of 1.45 for API. Kaplan-Meier analysis indicated an association of API with the primary outcome (79% for API ≥ 1.45 vs 48% for API < 1.45). In multivariable analysis, higher API was strongly associated with freedom from AT or death (OR 0.38, 95% CI 0.22-0.65, p≤0.001), even when adjusted for baseline characteristics and routine RHC measurements.\n\n\nCONCLUSION\nAPI is a novel invasive hemodynamic measurement that is independently associated with freedom from AT or death at 30-day follow-up.