Mazimba Sula, Welch Timothy S, Mwansa Hunter, Breathett Khadijah K, Kennedy Jamie L W, Mihalek Andrew D, Harding William C, Mysore Manu M, Zhuo David X, Bilchick Kenneth C
Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA.
Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA.
Heart Lung Circ. 2019 May;28(5):752-760. doi: 10.1016/j.hlc.2018.04.280. Epub 2018 Apr 17.
Pulmonary artery (PA) pulsitility index (PAPi) is a novel haemodynamic index shown to predict right ventricular failure in acute inferior myocardial infarction and post left ventricular assist device surgery. We hypothesised that PAPi calculated as [PA systolic pressure - PA diastolic pressure]/right atrial pressure (RAP) would be associated with mortality in the National Institutes of Health Registry for Primary Pulmonary Hypertension (NIH-RPPH).
The impact of PAPi, the Pulmonary Hypertension Connection (PHC) risk score, right ventricular stroke work, pulmonary artery capacitance (PAC), other haemodynamic indices, and demographic characteristics was evaluated in 272 NIH-RPPH patients using multivariable Cox proportional hazards (CPH) regression and receiver operating characteristic (ROC) analysis.
In the 272 patients (median age 37.7+/-15.9years, 63% female), the median PAPi was 5.8 (IQR 3.7-9.2). During 5years of follow-up, 51.8% of the patients died. Survival was markedly lower (32.8% during the first 3years) in PAPi quartile 1 compared with the remaining patients (58.5% over 3years in quartiles 2-4; p<0.0001). The best multivariable CPH survival model included PAPi, the PHC-Risk score, PAC, and body mass index (BMI). In this model, the adjusted hazard ratio for death with increasing PAPi was 0.946 (95% CI 0.905-0.989). The independent ROC areas for 5-year survival based on bivariable logistic regression for PAPi, BMI, PHC Risk, and PAC were 0.63, 0.62, 0.64, and 0.65, respectively (p<0.01). The ROC area for 5-year survival for the multivariable logistic model with all four covariates was 0.77 (p<0.0001).
Pulmonary artery pulsatility index was independently associated with survival in PAH, highlighting the utility of PAPi in combination with other key measures for risk stratification in this population.
肺动脉（PA）搏动指数（PAPi）是一种新的血流动力学指标，已被证明可预测急性下壁心肌梗死和左心室辅助装置植入术后的右心室衰竭。我们假设，以[肺动脉收缩压-肺动脉舒张压]/右心房压力（RAP）计算的PAPi与美国国立卫生研究院原发性肺动脉高压登记处（NIH-RPPH）的死亡率相关。
使用多变量Cox比例风险（CPH）回归和受试者工作特征（ROC）分析，对272例NIH-RPPH患者评估PAPi、肺动脉高压关联（PHC）风险评分、右心室搏功、肺动脉电容（PAC）、其他血流动力学指标和人口统计学特征的影响。
在272例患者（中位年龄37.7±15.9岁，63%为女性）中，中位PAPi为5.8（四分位间距3.7-9.2）。在5年随访期间，51.8%的患者死亡。与其余患者相比，第1四分位数的PAPi患者生存率明显较低（前3年为32.8%）（第2-4四分位数3年生存率为58.5%；p<0.0001）。最佳多变量CPH生存模型包括PAPi、PHC风险评分、PAC和体重指数（BMI）。在该模型中，随着PAPi升高，死亡的调整风险比为0.946（95%CI 0.905-0.989）。基于PAPi、BMI、PHC风险和PAC的二元逻辑回归的5年生存独立ROC面积分别为0.63、0.62、0.64和0.65（p<0.01）。包含所有四个协变量的多变量逻辑模型的5年生存ROC面积为0.77（p<0.0001）。
肺动脉搏动指数与PAH患者的生存独立相关，突出了PAPi与其他关键指标联合用于该人群风险分层的效用。
