Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, CB2 0AY, UK.
J Card Fail. 2020 Apr;26(4):352-359. doi: 10.1016/j.cardfail.2020.01.014. Epub 2020 Jan 23.
The pulmonary artery pulsatility index (PAPi) is a composite measure of right heart function, and low PAPi is associated with increased likelihood of mortality in patients hospitalized with cardiogenic shock. Our aim was to determine how PAPi correlates with other measures of right heart function and whether PAPi is associated with outcomes in ambulatory outpatients with advanced heart failure.
We assessed 673 consecutive ambulatory outpatients for heart transplantation over 10 years. The median age was 52 years, 72% were male, and dilated cardiomyopathy was the most common cause. All patients underwent detailed assessment, including right heart catheterization, and PAPi was calculated. The coprimary endpoints were death, urgent heart transplantation and mechanical circulatory support.
Median PAPi was 2.2 (interquartile range 1.42-3.62), and variation was predominantly due to variation in right atrial pressure. PAPi was well correlated with the right atrial pressure to pulmonary capillary wedge pressure ratio (rho -0.766) but less well correlated with the right ventricular stroke work index (rho 0.561) and tricuspid annular plane systolic excursion (rho 0.292). Patients in the lowest PAPi quartile (0.16-1.41) had lower event-free survival at 1 year (68.7%) and 3 years (45.6%) compared with all other PAPi quartiles (log rank P = 0.0286).
PAPi offers a composite measure of right heart function that differs from other right heart catheter or echocardiographic measures. A PAPi of less than 1.41 is associated with adverse clinical outcomes in ambulatory outpatients with advanced heart failure.
肺动脉搏动指数（PAPi）是右心功能的综合指标，低 PAPi 与心源性休克住院患者死亡率增加相关。我们的目的是确定 PAPi 与其他右心功能指标的相关性，以及 PAPi 是否与晚期心力衰竭的门诊患者的预后相关。
我们在 10 年内评估了 673 例连续的门诊心力衰竭患者进行心脏移植。中位年龄为 52 岁，72%为男性，扩张型心肌病是最常见的病因。所有患者均接受详细评估，包括右心导管检查，并计算 PAPi。主要终点是死亡、紧急心脏移植和机械循环支持。
中位 PAPi 为 2.2（四分位间距 1.42-3.62），变异主要是由于右心房压力的变化。PAPi 与右心房压力与肺毛细血管楔压的比值密切相关（rho-0.766），但与右心室每搏功指数（rho 0.561）和三尖瓣环平面收缩期位移（rho 0.292）的相关性较差。PAPi 最低四分位数（0.16-1.41）的患者在 1 年（68.7%）和 3 年（45.6%）时无事件生存率较低，与其他所有 PAPi 四分位数相比（对数秩 P=0.0286）。
PAPi 提供了一种综合的右心功能指标，与其他右心导管或超声心动图指标不同。PAPi 小于 1.41 与晚期心力衰竭门诊患者的不良临床结局相关。
