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 [1] 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 [2].

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 [3]. PAPi was significantly associated with clinical features of right ventricular like elevated jugular venous pressure, ascites and edema. Similarly echocardiographic signs of right ventricular failure like increased size of right atrium and inferior vena cava, tricuspid regurgitation velocity were significantly associated with PAPi. Hemodynamic signs of right ventricular failure like elevated right atrial pressure was also significantly associated with PAPi. PAPi was an independent predictor of primary endpoint of death or hospitalization at 6 months [3].

PAPi was found to be useful in primary pulmonary hypertension as well. Two hundred and seventy two patients from the National Institutes of Health Registry for Primary Pulmonary Hypertension were evaluated by Sula Mazimba and colleagues. They found that PAPi was independently associated with survival in primary pulmonary hypertension [4].

References

1. Ravi Korabathina, Kevin S Heffernan, Vikram Paruchuri, Ayan R Patel, James O Mudd, Jordan M Prutkin, Nicole M Orr, Andrew Weintraub, Carey D Kimmelstiel, Navin K Kapur. The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv. 2012 Oct 1;80(4):593-600.
2. 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.
3. 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.
4. Sula Mazimba, Timothy S Welch, Hunter Mwansa, Khadijah K Breathett, Jamie L W Kennedy, Andrew D Mihalek, William C Harding, Manu M Mysore, David X Zhuo, Kenneth C Bilchick. Haemodynamically Derived Pulmonary Artery Pulsatility Index Predicts Mortality in Pulmonary Arterial Hypertension. Heart Lung Circ. 2019 May;28(5):752-760.