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

作者：Mazimba Sula^*; Kennedy Jamie L W; Zhuo David; Bergin James; Abuannadi Mohammad; Tallaj Jose; Bilchick Kenneth C

来源：Journal of Cardiac Failure, 2016, 22(12): 954-961.

DOI：10.1016/j.cardfail.2016.03.019

• Pulmonary hypertension
• hemodynamics
• proportional pulse pressure
• congestive heart failure

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.

• 出版日期2016-12