Author + information
- Sula Mazimba,
- Timothy Welch,
- Peter McCullough,
- Khadijah Breathett,
- Jose Tallaj,
- James Bergin,
- Jamie Kennedy,
- Lavone Smith,
- Mohammad Abuannadi and
- Kenneth Bilchick
Background: Ventricular-arterial (VA) coupling has been shown to have physiologic importance in heart failure (HF). We hypothesized that systemic arterial pulsatility index (SAPi = [systemic systolic pressure-systemic diastolic pressure]/pulmonary capillary wedge pressure) would be associated with adverse outcomes in patients with advanced HF.
Methods: We evaluated the SAPi obtained from the final hemodynamic measurements in patients randomized to pulmonary arterial catheter (PAC) guided therapy in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Cox proportional hazards regression was performed for the outcomes of: a) death, transplant, or left ventricular assist device (DTxLVAD), and b) DTxLVAD or rehospitalization (DTxLVADHF).
Results: Among 142 patients with complete data (mean age 56.8 ± 13.3 years, 30.3% female), the median SAPi was 2.57 (IQR 1.63-3.45). Increasing SAPi was associated with significant reductions in DTxLVAD (HR 0.60 per unit increase in SAPi, 95% CI 0.44-0.84) and DTxLVADHF (HR 0.81 per unit increase, 95% CI 0.70-0.95). Patients with a SAPi ≤ 2.41 had a marked increase in both outcomes, including more than twice the risk of DTxLVAD (HR 2.19, 95% CI 1.11-4.30) over the 6 months (Figure).
Conclusions: SAPi, a novel index of VA coupling, integrates pulse pressure and a proxy for left ventricular end-diastolic pressure is strongly associated with adverse clinical outcomes in advanced HF.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in HCM, PPCM and Other Cardiomyopathies
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1201-296
- 2017 American College of Cardiology Foundation