Aortic pulsatility index predicts clinical outcomes in heart failure: a sub-analysis of the ESCAPE trial.
Acute decompensated heart failure
Catheterization
Haemodynamics
Heart failure
Pulse pressure
Journal
ESC heart failure
ISSN: 2055-5822
Titre abrégé: ESC Heart Fail
Pays: England
ID NLM: 101669191
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
19
01
2021
received:
02
11
2020
accepted:
23
01
2021
pubmed:
18
2
2021
medline:
2
7
2021
entrez:
17
2
2021
Statut:
ppublish
Résumé
Aortic pulsatility index (API), calculated as (systolic-diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP), is a novel haemodynamic measurement representing both cardiac filling pressures and contractility. We hypothesized that API would better predict clinical outcomes than traditional haemodynamic metrics of cardiac function. The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial individual-level data were used. Routine haemodynamic measurements, including Fick cardiac index (CI), and the advanced haemodynamic metrics of API, cardiac power output (CPO), and pulmonary artery pulsatility index (PAPI) were calculated after final haemodynamic-monitored optimization. The primary outcome was a composite endpoint of death or need for orthotopic heart transplant (OHT) or left ventricular assist device (LVAD) at 6 months. A total of 433 participants were enrolled in the ESCAPE trial of which 145 had final haemodynamic data. Final API measurements predicted the primary outcome, OR 0.47 (95% CI 0.32-0.70, P < 0.001), while CI, CPO, and PAPI did not. Receiver operator characteristic analyses of final advanced haemodynamic measurements indicated API best predicted the primary outcome with a cutoff of 2.9 (sensitivity 76.2%, specificity 55.3%, correctly classified 61.4%, area-under-the-curve 0.71), compared with CPO, CI, and PAPI. Kaplan-Meier analyses indicated API ≥ 2.9 was associated with greater freedom from the primary outcome (83.5%), compared with API < 2.9 (58.4%), P = 0.001. While PAPI was also significantly associated, CI and CPO were not. The novel haemodynamic measurement API better predicted clinical outcomes in the ESCAPE trial when compared with traditional invasive haemodynamic metrics of cardiac function.
Identifiants
pubmed: 33595923
doi: 10.1002/ehf2.13246
pmc: PMC8006667
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1522-1530Informations de copyright
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Références
ESC Heart Fail. 2021 Apr;8(2):1522-1530
pubmed: 33595923
J Am Coll Cardiol. 1988 Feb;11(2):438-45
pubmed: 3276755
BMJ Open. 2016 Sep 26;6(9):e012769
pubmed: 27670522
Circ Heart Fail. 2014 Jul;7(4):590-5
pubmed: 24874200
J Card Fail. 2016 Mar;22(3):182-9
pubmed: 26703245
J Am Coll Cardiol. 2017 Aug 8;70(6):776-803
pubmed: 28461007
Circ Heart Fail. 2012 Jan;5(1):54-62
pubmed: 22167320
J Am Coll Cardiol. 1992 Jul;20(1):248-54
pubmed: 1351488
J Card Fail. 2018 Jul;24(7):453-459
pubmed: 29597051
Circulation. 1991 Mar;83(3):778-86
pubmed: 1999029
J Am Coll Cardiol. 2018 Jan 16;71(2):201-230
pubmed: 29277252
N Engl J Med. 1999 Aug 19;341(8):577-85
pubmed: 10451464
J Heart Lung Transplant. 2006 Sep;25(9):1024-42
pubmed: 16962464
J Am Coll Cardiol. 2010 Mar 2;55(9):872-8
pubmed: 20185037
JAMA. 2005 Oct 5;294(13):1625-33
pubmed: 16204662
Circulation. 2019 Mar 5;139(10):e56-e528
pubmed: 30700139
JAMA Cardiol. 2017 Jan 1;2(1):98-99
pubmed: 27806174