Aortic Pulsatility Index, A New Hemodynamic Assessment, Predicts Cardiovascular Death At 1 Year.

Abstract

<h3>Introduction</h3> Heart failure with reduced ejection fraction (HFrEF) remains one of the leading causes of cardiovascular death and morbidity. Identifying patients most at risk for death remains a key component in the decision making in implementing advanced therapies. In this study, we evaluate the aortic pulsatility index to risk stratify patients. <h3>Methods</h3> : A total of 79 consecutive patients with reduced systolic function undergoing right heart catherization for HFrEF were identified in 2019. Statistics were performed with clinical characteristics and continuous variables were expressed as means +/- standard deviations (STD) or medians with interquartile ranges and compared with either Student t tests or Mann-Whitney U (Wilcoxon) tests. <h3>Results</h3> : Seventy-nine patients were included in the final analysis. Aortic pulsatility index average +/- STD across all patients was 2.53 +/- 1.72. Cardiac power output (CPO) average +/- STD was 0.79 +/- 0.32. Ten patients had expired at 1 year and API was predictive of death at 1 year, p = 0.013 while CPO, Fick cardiac output (FCo), and thermodilution cardiac output (ThCo) did not, p = 0.52, 0.79, 0.073 respectively (Figure 1a). Fourteen patients required advanced therapies, defined as heart transplant, left ventricular assist device, or inotropic therapy. API, but not CPO, FCo, or ThCo was associated with need for advanced therapies or death at 1 year, p = 0.006 vs p = 0.92, 0.25, 0.34 respectively (Figure 1b). In deceased patients, average API was 1.44 +/- 0.3 vs 2.7 +/- 1.78 in surviving patients, p<<0.001 (Figure 1c). A receiver operating curve was plotted for API vs death, with area under the curve being 0.745, p = 0.013 (Figure 2). <h3>Conclusion</h3> : API provides discriminatory information over standard hemodynamic measurements including isolated measurements of right and left filling pressures, CPO, and FCo or ThCo for cardiovascular death or need for advanced therapies at 1 year. API can be used to aid decision making in identifying patients at highest risk for death in order to direct advanced therapies to these patients most in need.