Systemic Arterial Pulsatility Index Predicts Adverse Outcomes in Cardiogenic Shock

Abstract

Background Ventricular-arterial (VA) coupling has previously been shown to have physiologic importance in heart failure (HF). We hypothesized that a decreased systemic arterial pulsatility index (SAPi = [systemic systolic pressure - systemic diastolic pressure] / pulmonary capillary wedge pressure) would be associated with the adverse clinical outcomes in patients with systolic heart failure in cardiogenic shock (CS). Methods This was a retrospective study from a tertiary academic center. Patients with CS admitted to the coronary care unit (wedge pressure ≥15, cardiac index ≤2.2, and systolic blood pressure ≤90) were included. Using logistic regression analysis, we evaluated the association of SAPi to the outcomes of death or left ventricular assist device (LVAD). Results Among 119 patients with complete data (mean age 60.3 ± 14.7 years, 29% female), the median SAPi was 1.24 (IQR 0.91-1.68). Decreasing SAPi was strongly associated with outcome of death or LVAD [OR 0.52 (95% CI 0.29-0.95, chi square 4.54, p=0.03)]. Receiver operating characteristic curve analysis yielded an area under the curve (AUC) of 0.62 ± 0.06 (95% CI 0.490.73). Conclusion SAPi, an index of VA coupling, integrates pulse pressure and a proxy of left ventricular end-diastolic pressure. A decreased SAPi is strongly associated with adverse clinical outcomes in patients with CS and warrants consideration as a risk stratification tool.