Prognostic Impact of Hemodynamic Transitions in Pulmonary Artery Pulsatility Index and Compliance in Advanced Heart Failure: A Post-hoc Analysis of the ESCAPE Trial
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Advanced heart failure (HF) remains associated with poor outcomes despite contemporary therapies. Right ventricular (RV) dysfunction, a hallmark of advanced HF, is strongly influenced by afterload. We aimed to evaluate whether the combined assessment of the pulmonary artery pulsatility index (PAPi) and pulmonary arterial capacitance (PAC)-and their transitions during acute-phase therapy-provides prognostic stratification in patients with advanced HF.
Methods
We conducted a post-hoc analysis of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial, including 146 patients with complete hemodynamic data. A bootstrap-based grid search identified prognostic cutoffs: PAPi at 2.67 and PAC at 2.03. The optimal zone was defined as PAPi ≥2.67 and PAC ≥2.03; the suboptimal zone as PAPi <2.67 or PAC <2.03. Patients were categorized into four groups based on transitions between zones from baseline to the final assessment after acute-phase therapy. The primary endpoint was a composite of all-cause mortality, left ventricular assist device implantation, or heart transplantation within 6 months.
Results
At baseline, 127 patients were in the suboptimal zone. Following acute-phase therapy, 33 transitioned to the optimal zone, while 94 remained suboptimal . Kaplan–Meier curves demonstrated significant stratification among groups. In Cox regression models using the suboptimal→suboptimal as reference, transition to the suboptimal→optimal was associated with improved prognosis (multivariable hazard ratio 0.300, 95% confidence interval 0.107–0.847, P=0.023).
Conclusions
Transitions in PAPi and PAC during acute-phase therapy were associated with subsequent outcomes in advanced HF. Combined assessment of PAPi and PAC may provide a novel therapeutic target for risk stratification and management in this high-risk population.
