Acute decompensated heart failure: systolic pulmonary artery pressure cut off value to define presence of congestion

Background and Aims: Pulmonary and/or peripheral venous congestion defines the clinical diagnosis of acute heart failure (HF). However, the systolic pulmonary arterial pressure (sPAP) thresholds at which pulmonary (chest X-ray) and inferior vena cava (IVC) congestion occur are not well established. This study aimed to identify a cut-off value of sPAP that reliably indicates acute HF. Methods and Results: We retrospectively included 380 consecutive patients hospitalized for acute HF at an Italian referral center, excluding those with severe tricuspid regurgitation. Receiver operating characteristic (ROC) curve analysis and Youden’s J statistic identified a threshold of sPAP ≥ 48.75 mmHg as the most accurate in predicting both pulmonary (sensitivity = 89.9%, specificity = 73%) and peripheral (sensitivity = 88.3%, specificity = 82.5%) fluid overload. The association between this sPAP threshold and both pulmonary and peripheral congestion was confirmed by chi-square testing (p < 0.001) and multivariate logistic regression (p < 0.001). After adjustment for confounders, sPAP ≥ 48.75 mmHg was independently associated with all-cause death or HF hospitalization (HR = 1.713; 95% CI 1.127–2.602; p = 0.012). Conclusions: Acute HF decompensation is characterized by at least moderately elevated sPAP values.