Decreased Pulmonary Arterial Proportional Pulse Pressure After Pulmonary Artery Catheter Optimization for Advanced Heart Failure Is Associated With Adverse Clinical Outcomes.

Pubmed ID: 27095529

Journal: Journal of cardiac failure

Publication Date: Dec. 1, 2016

Affiliation: Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia.

MeSH Terms: Humans, Male, Female, Aged, Cohort Studies, Middle Aged, Proportional Hazards Models, Heart Failure, Hospitalization, Treatment Outcome, Blood Pressure, Survival Rate, Catheterization, Swan-Ganz, Pulmonary Artery

Authors: Tallaj J, Mazimba S, Zhuo D, Bergin J, Abuannadi M, Bilchick KC, Kennedy JLW

Cite As: Mazimba S, Kennedy JLW, Zhuo D, Bergin J, Abuannadi M, Tallaj J, Bilchick KC. Decreased Pulmonary Arterial Proportional Pulse Pressure After Pulmonary Artery Catheter Optimization for Advanced Heart Failure Is Associated With Adverse Clinical Outcomes. J Card Fail 2016 Dec;22(12):954-961. Epub 2016 Apr 14.

Studies:

Abstract

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. METHODS AND 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.