title: Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation.
abstract: BACKGROUND
  Right ventricular failure (RVF) is a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. The pulmonary artery pulsatility index (PAPi) is a novel hemodynamic index that predicts RVF in the setting of myocardial infarction, although it has not been shown to predict RVF after LVAD implantation.
  
  
  METHODS
  We performed a retrospective, single-center analysis to examine the utility of the PAPi in predicting RVF and RV assist device (RVAD) implantation in 85 continuous-flow LVAD recipients. We performed a multivariate logistic regression analysis incorporating previously identified predictors of RVF after LVAD placement, including clinical and echocardiographic variables, to determine the independent effect of PAPi in predicting RVF or RVAD after LVAD placement.
  
  
  RESULTS
  In this cohort, the mean PAPi was 3.4 with a standard deviation of 2.9. RVF occurred in 33% of patients, and 11% required a RVAD. Multivariate analysis, adjusting for age, blood urea nitrogen (BUN), and Interagency Registry for Mechanically Assisted Circulatory Support profile, revealed that higher PAPi was independently associated with a reduced risk of RVAD placement (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.07-0.89). This relationship did not change significantly when echocardiographic measures were added to the analysis. Stratifying the analysis by the presence of inotropes during catheterization revealed that PAPi was more predictive of RVAD requirement when measured on inotropes (OR, 0.21; 95% CI, 0.02-0.97) than without (OR, 0.49; 95% CI, 0.01-1.94). Furthermore, time from catheterization to LVAD did not significantly affect the predictive value of the PAPi (maximum time, 6 months). Receiver operating characteristic curve analysis revealed that optimal sensitivity and specificity were achieved using a PAPi threshold of 2.0.
  
  
  CONCLUSIONS
  In LVAD recipients, the PAPi is an independent predictor of RVF and the need for RVAD support after LVAD implantation. This index appears more predictive in patients receiving inotropes and was not affected by time from catheterization to LVAD in our cohort.
authors.affiliation: Department of Medicine, the Stanford University School of Medicine.
authors.forename: Guson
authors.initials: G
authors.lastname: Kang
authors.affiliation: Division of Adult Cardiac Surgery, Department of Cardiothoracic Surgery.
authors.forename: Richard
authors.initials: R
authors.lastname: Ha
authors.affiliation: Department of Medicine, the Stanford University School of Medicine; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: dipanjan@stanford.edu.
authors.forename: Dipanjan
authors.initials: D
authors.lastname: Banerjee
mesh_terms: D002140:California / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology*; D011673:Pulsatile Flow / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology
keywords: LVAD; heart failure; pulmonary artery pulsatility index; right ventricle; ventricular assist device