Pulmonary Artery Pulsatility Index

Pulmonary Artery Pulsatility Index

Pulmonary Artery Pulsatility Index (PAPI) is a recently described hemodynamic index, which has been used to predict right ventricular failure in those with inferior wall infarction and in those who have been implanted with left ventricular assist device (LVAD). It is also useful to assess the need for biventricular Impella (Bipella) support in those with cardiogenic shock on the mechanical circulatory support device Impella for the left ventricle [1].

Pulmonary artery pulsatility index (PAPI) = (systolic pulmonary arterial pressure − diastolic pulmonary pressure)/right atrial pressure.

This is the pulmonary arterial pulse pressure divided by the right atrial pressure (right ventricular filling pressure). PAPI can serve as a marker of right ventricular dysfunction in patients with advanced heart failure and was found to strongly predict adverse clinical events in the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial [2].


  1. Rab T, Ratanapo S, Kern KB, Basir MB, McDaniel M, Meraj P, King SB 3rd, O’Neill W. Cardiac Shock Care Centers: JACC Review Topic of the Week. J Am Coll Cardiol. 2018 Oct 16;72(16):1972-1980.
  2. Kochav SM, Flores RJ, Truby LK, Topkara VK. Prognostic Impact of Pulmonary Artery Pulsatility Index (PAPi) in Patients With Advanced Heart Failure: Insights From the ESCAPE Trial. J Card Fail. 2018 Jul;24(7):453-459.