Abstract 14388: Aortic Pulsatility Index Strongly Predicts Clinical Outcomes in Heart Failure Patients: A Sub-analysis of the Escape Trial

Abstract

Introduction: Aortic pulsatility index (API), calculated as (systolic - diastolic blood pressure)/pulmonary capillary wedge pressure, is a novel hemodynamic measurement representing cardiac filling pressures and contractility. Hypothesis: API would better predict clinical outcomes than traditional hemodynamic metrics of cardiac function in decompensated heart failure patients. Methods: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial individual-level data were used. API, cardiac power output (CPO), Fick cardiac index (CI), and pulmonary artery pulsatility index (PAPI) were calculated after final hemodynamic-monitored optimization. The primary outcome, assessed by univariable analysis, was combined death or need for heart transplant or left ventricular assist device at six months. Receiver operator characteristic (ROC) analyses were used to determine the cutoff value, from which Kaplan-Meier (KM) curves were constructed. Results: A total of 433 patients were enrolled in the ESCAPE trial, of which 155 had accurate final hemodynamic data. Of these, 45 (29%) experienced the primary outcome. Final API measurements predicted the primary outcome, OR 0.45 (95% CI 0.30-0.70, p<0.001), while CI, CPO, and PAPI did not. ROC analyses of final advanced hemodynamic measurements indicated API best predicted the primary outcome with a cutoff (sensitivity, specificity, correctly classified, AUC) of 2.9 (76.2%, 55.3%, 61.4%, 0.71), compared to CPO 0.69 (57.8%, 57.8%, 57.4%, 0.57), CI 2.2 (50.0%, 48.2%, 48.7%, 0.52), and PAPI 2.6 (60.5%, 64.5%, 63.3%, 0.64). KM analyses indicated API (83.5% vs 58.4%, p=0.001) and PAPI (78.3% vs 59.0%, p=0.03) were predictive of freedom from the primary outcome, but not CPO or CI. Conclusions: The novel hemodynamic measurement API better predicted clinical outcomes in the ESCAPE trial when compared to traditional invasive hemodynamic metrics of cardiac function.