Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma.
Cardiovascular Department, San Donato Hospital, Arezzo, Italy.
Eur Heart J Acute Cardiovasc Care. 2022 Aug 9;11(8):629-639. doi: 10.1093/ehjacc/zuac085.
Pulmonary artery pulsatility index (PAPi) is an indicator of right ventricular (RV) function and an independent predictor of right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation. Administration of vasodilator challenge during right heart catheterization (RHC) could reduce RV workload allowing a better assessment of its functional reserve.
Patients undergoing LVAD implantation at our Institution between May 2013 and August 2021 were enrolled. Only patients who had undergone RHC and vasodilator challenge with sodium nitroprusside were analyzed. We collected all available clinical, instrumental, and haemodynamic parameters, at baseline and after nitroprusside infusion and evaluated potential associations with post-LVAD RVF. Of the 54 patients analyzed, 19 (35%) developed RVF after LVAD implantation. Fractional area change (FAC) (OR: 0.647, CI: 0.481-0.871; P = 0.004), pulmonary artery systolic pressure (PASP) (OR: 0.856, CI: 0.761-0.964; P = 0.010), and post-sodium nitroprusside (NTP) PAPi (OR: 0.218, CI: 0.073-0.653; P = 0.006) were independent predictors of post-LVAD RVF. The model combining FAC, PASP, and post-NTP PAPi demonstrated a predictive accuracy of 90.7%. Addition of post-NTP PAPi significantly increased the predictive accuracy of the European Registry for Patients with Mechanical Circulatory Support right-sided heart failure risk score [79.4 vs. 70.4%; area under the curve (AUC): 0.841 vs. 0.724, P = 0.022] and the CRITT score (79.6% vs. 74%; AUC: 0.861 vs. 0.767 P = 0.033).
Post-NTP PAPi has observed to be an independent predictor of RVF following LVAD implantation. Dynamic assessment of PAPi using a vasodilator challenge may represent a method of testing RV functional reserve in candidates for LVAD implantation. Larger and prospective studies are needed to confirm this hypothesis.
肺动脉搏动指数（PAPi）是右心室（RV）功能的指标，也是左心室辅助装置（LVAD）植入后右心衰竭（RVF）的独立预测因子。在右心导管检查（RHC）期间给予血管扩张剂挑战可以减轻 RV 工作量，从而更好地评估其功能储备。
本研究纳入了 2013 年 5 月至 2021 年 8 月期间在我院接受 LVAD 植入的患者。仅分析了接受 RHC 和硝普钠血管扩张剂挑战的患者。我们收集了所有基线时和硝普钠输注后的临床、仪器和血流动力学参数，并评估了它们与 LVAD 后 RVF 的潜在关联。在 54 名接受分析的患者中，19 名（35%）在 LVAD 植入后发生 RVF。分数面积变化（FAC）（OR：0.647，CI：0.481-0.871；P=0.004）、肺动脉收缩压（PASP）（OR：0.856，CI：0.761-0.964；P=0.010）和硝普钠后 PAPi（OR：0.218，CI：0.073-0.653；P=0.006）是 LVAD 后 RVF 的独立预测因子。结合 FAC、PASP 和硝普钠后 PAPi 的模型显示出 90.7%的预测准确性。添加硝普钠后 PAPi 显著提高了欧洲机械循环支持患者登记处右心衰竭风险评分（79.4%比 70.4%；曲线下面积（AUC）：0.841 比 0.724，P=0.022）和 CRITT 评分（79.6%比 74%；AUC：0.861 比 0.767，P=0.033）的预测准确性。
硝普钠后 PAPi 是 LVAD 植入后 RVF 的独立预测因子。使用血管扩张剂挑战对 PAPi 进行动态评估可能是测试 LVAD 植入候选者 RV 功能储备的一种方法。需要更大规模的前瞻性研究来证实这一假设。
