PULMONARY ARTERIAL PULSATILITY INDEX AS A PREDICTOR OF MORTALITY IN PULMONARY ARTERIAL HYPERTENSION

Abstract

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pulmonary arterial hypertension (PAH) is a condition characterized by an increase in pulmonary artery pressure (PAP) and right ventricular (RV) afterload, leading to RV failure and mortality. Right heart catheterization (RHC) remains the mainstay of diagnosis of pulmonary arterial hypertension and provides important prognostic information. The pulmonary arterial pulsatility index (PAPi), calculated as pulmonary arterial pulse pressure divided by right atrial pressure (RAP), has recently been suggested as a predictor of mortality in PAH. We aimed to determine whether the PAPi at diagnosis is associated with mortality in PAH. METHODS: We conducted a retrospective single-centre cohort study of incident patients ≥ 18 years old diagnosed with PAH by RHC between January 1, 2015 and April 31, 2019. PAPi was calculated as pulmonary arterial pulse pressure (systolic PAP – diastolic PAP) divided by RAP. The primary outcome was all-cause mortality. Cox regression analysis and Kaplan-Meier plots were used to assess the association between PAPi and mortality. RESULTS: There were 98 incident patients identified (mean age 59.6 ± 1.5 at diagnosis, 67% female). Mean PAP was 46 ± 1.2 mmHg, mean RAP was 9.6 ± 0.6 mmHg, and mean pulmonary vascular resistance was 9.1 ± 0.5 Wood Units. Twenty-five (26%) of patients received no initial therapy, 44 (45%) patients received initial oral monotherapy, 25 (26%) received dual oral combination therapy and 4 (4%) received triple therapy. Using the median PAPi value of 5.4, two groups were created. Baseline characteristics across groups (PAPi < 5.4 vs. ≥ 5.4) were primarily female (71% vs. 63%, p = 0.39); mean age 58 ± 2.2 years vs. 61 ± 2.2 years (p=0.31); mean body mass index 31.1 ± 1.4 kg/m2 vs. 28.0 ± 0.9 kg/m2 (p=0.06); and mean initial six minute walk distance 335 ± 20 m vs. 365 ± 20 m (p=0.29). There was no difference in the proportion of patients in New York Heart Association functional class I-II vs. III-IV between groups (p=0.69). Treatment strategy with no PAH therapy, monotherapy, dual therapy and triple therapy did not differ significantly between PAPi < 5.4 and PAPi ≥ 5.4 groups (22% vs. 29%, p=0.49; 51% vs. 38%, p=0.22; 24% vs. 26%, p=0.2; 2% vs. 6%, p = 0.31). There were 21 deaths during the follow-up period. In Cox regression modelling, those with PAPi ≥ 5.4 had a mortality hazard ratio, adjusted for age and sex, of 0.41 (95% CI 0.16-1.08, p=0.07). CONCLUSIONS: In this cohort, baseline PAPi ≥ 5.4 was associated with a trend toward lower all-cause mortality. A Canadian multicentre analysis is planned to help further validate whether PAPi predicts outcomes in a larger PAH population. CLINICAL IMPLICATIONS: PAPi is a useful prognostic variable in left heart failure and could also potentially be useful in PAH. Further studies are needed to compare PAPi with other invasive and non-invasive prognostic variables in PAH. DISCLOSURES: Industry sponsored clinical trial relationship with Johnson and Johnson Please note: $5001 - $20000 Added 06/13/2020 by Doug Helmersen, source=Web Response, value=Grant/Research Support Industry sponsored clinical trial relationship with United Therapeutics Please note: $5001 - $20000 Added 06/13/2020 by Doug Helmersen, source=Web Response, value=Grant/Research Support Industry sponsored clinical trial relationship with Bayer Please note: $20001 - $100000 Added 06/13/2020 by Doug Helmersen, source=Web Response, value=Grant/Research Support industry sponsored clinical trial relationship with Gilead Please note: $5001 - $20000 Added 06/13/2020 by Doug Helmersen, source=Web Response, value=Grant/Research Support Speaker/Speaker's Bureau relationship with Bayer Please note: $1001 - $5000 Added 06/13/2020 by Doug Helmersen, source=Web Response, value=Honoraria Investigator relationship with Bayer Pharmaceuticals Please note: $20001 - $100000 Added 06/11/2020 by Naushad Hirani, source=Web Response, value=Grant/Research Support Advisory Committee Member relationship with Actelion Canada Please note: $1001 - $5000 Added 06/11/2020 by Naushad Hirani, source=Web Response, value=Honoraria No relevant relationships by Jonathan Liu, source=Web Response No relevant relationships by Jordan Sugarman, source=Web Response No relevant relationships by Mitesh Thakrar, source=Web Response No relevant relationships by Rhea Varughese, source=Web Response Speaker/Speaker's Bureau relationship with Actelion Please note: $20001 - $100000 Added 04/04/2020 by Jason Weatherald, source=Web Response, value=Honoraria Consultant relationship with Actelion/Janssen Please note: $5001 - $20000 Added 04/04/2020 by Jason Weatherald, source=Web Response, value=Consulting fee Travel support relationship with Actelion/Janssen Please note: $1001 - $5000 Added 04/04/2020 by Jason Weatherald, source=Web Response, value=Travel Grant/Research relationship with Janssen Please note: $20001 - $100000 Added 04/04/2020 by Jason Weatherald, source=Web Response, value=Grant/Research Speaker/Speaker's Bureau relationship with Bayer Please note: $1001 - $5000 Added 04/04/2020 by Jason Weatherald, source=Web Response, value=Honoraria