Serial Assessment of Pulmonary Artery Pulsatility Index Provides Incremental Risk Assessment for Early Right Ventricular Failure after Left Ventricular Assist Device Implantation.

Purpose PAPi (pulmonary artery pulsatility index) is a predictor of early right ventricular failure (RVF) post left ventricular assist device (LVAD) implantation and has been studied using hemodynamics from single, isolated time points. Since multiple clinical factors and therapies are known to impact RV function in pre-LVAD patients, we hypothesized that serial PAPi measurements would provide incremental risk stratification for early post-LVAD RVF. Methods A total of 394 consecutive patients undergoing primary durable LVAD implantation at our center from 2004 to 2017 were retrospectively enrolled. Serial invasive hemodynamics obtained during inpatient swan guided therapy (77%) or consecutive outpatient right heart catheterizations were recorded. The lowest, highest ("Best"), change ("Delta") and most proximal PAPi to LVAD implant were calculated. RVF was defined as need for RVAD or prolonged inotrope use > 14 days post-operatively. Multivariate logistic regression determining independent associates of early RVF was performed. Results RVF occurred in 82 of the 394 patients (21%). Those who developed early RVF had significantly lower mean Delta PAPi (2.0 vs 5.3, p<.001) and a significantly reduced Best PAPi (3.4 vs 7.4, p<.001) following optimization. In addition to sex, Michigan RVF risk score, INTERMACS profile, and Fick cardiac index, Best PAPi was independently associated with early RVF post-LVAD (OR.71, CI.62-.81, p<.0001). On receiver operating characteristics curve analysis, Best PAPi added significant incremental value for risk prediction of early RVF to a model containing clinical, echocardiographic and basic hemodynamic parameters (Figure). Conclusion The best PAPi achieved during medical optimization prior to LVAD implantation provides independent and incremental risk stratification for early RVF, likely identifying RV reserve. [ABSTRACT FROM AUTHOR]