Decreased Pulmonary Arterial Proportional Pulse Pressure After Pulmonary Artery Catheter Optimization for Advanced Heart Failure Is Associated With Adverse Clinical Outcomes.
BACKGROUND
This study evaluated the novel index pulmonary arterial proportional pulse pressure (PAPP) in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial.


RESULTS
Multivariable Cox proportional hazards and logistical regression were used to model 6-month death; death, transplantation, or left ventricular assist device (DTLVAD); and DTLVAD or heart failure rehospitalization (DTLVADHF) with respect to PAPP. Among 175 patients with final hemodynamic data, 15.5% and 33.9%, respectively, died in optimal PAPP (PAPP >0.50) and nonoptimal PAPP (PAPP ≤0.50) groups (P = .008), and PAPP was independently associated with death, DTLVAD, and DTLVADHF (P < .01 for all outcomes). The hypothesized logistic regression model with pulmonary capillary wedge pressure, creatinine, and nonoptimal PAPP had an area under the curve of 0.818 (P < .0001) for death. Furthermore, PAPP as a continuous variable was the most powerful predictor of DTLVADHF (hazard ratio 0.793 per 0.1 increase in PAPP [95% confidence interval 0.659-0.955], chi square 8.80; P = .01) in the Cox model, with no other clinical, laboratory, or hemodynamic parameters significant after adjustment for PAPP.


CONCLUSIONS
PAPP, a novel parameter for right-sided proportional pulse pressure, is an independent and powerful predictor of adverse clinical outcomes in advanced HF. Increased PAPP promises to be a useful therapeutic target in patients with pulmonary arterial pressure assessment.
Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia. Electronic address: sm8sd@virginia.edu.
Sula
S
Mazimba
Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia.
Jamie L W
JLW
Kennedy
Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia.
David
D
Zhuo
Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia.
James
J
Bergin
Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia.
Mohammad
M
Abuannadi
Department of Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Jose
J
Tallaj
Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia.
Kenneth C
KC
Bilchick
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002407:Catheterization, Swan-Ganz; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology*; D015996:Survival Rate; D016896:Treatment Outcome
Pulmonary hypertension; congestive heart failure; hemodynamics; proportional pulse pressure