Abstract
Introduction: Aortic pulsatility index (API), calculated as (systolic blood pressure - diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP), is a novel hemodynamic measurement representing cardiac filling pressures and contractility. Hypothesis: API would predict heart failure hospitalizations in acutely decompensated heart failure participants in the Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness (ESCAPE) trial. Methods: From the ESCAPE trial individual-level data API, cardiac power output (CPO), and pulmonary artery pulsatility index (PAPI) were calculated, as well as reported routine invasive hemodynamics at baseline and after final hemodynamic-monitored optimization. Outcomes assessed were need for any rehospitalization and time to any first rehospitalization. Univariable analysis was conducted to assess rehospitalization. Negative binomial regression was used to analyze duration of time from discharge to first rehospitalization. Results: A total of 433 patients were enrolled in the ESCAPE trial. 189 patients had complete, accurate baseline hemodynamic data and were included in this analysis. No baseline hemodynamic measurements were associated with either outcome, except pulmonary artery (PA) diastolic pressure which predicted rehospitalization (OR 1.05 (95% CI 1.00-1.05, p= 0.02). Final API, OR 0.75 (95% CI 0.60-1.00, p= 0.03) and PAPI, OR 0.90 (95% CI 0.80-1.00, p= 0.03) predicted the need for any rehospitalization. Final API, OR 0.84 (95% CI 0.73-0.97, p= 0.02), and PA diastolic pressure, OR 1.03 (95% CI 1.01-1.06, p= 0.02), were associated with duration of time from discharge to any first hospitalization. Conclusions: The novel hemodynamic measurement API better predicted rehospitalization and time to rehospitalization in the ESCAPE trial when compared to routine, and other advanced invasive hemodynamic measurements.
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