The Prognostic Impact of Pulmonary Artery Proportional Pulse Pressure in Patients with Right Ventricular Failure - A Single-Center, Retrospective Study

IntroductionThe pulmonary artery proportional pulse pressure (PAPP), an index of right ventricle to pulmonary artery coupling obtained by dividing the pulmonary artery pulse pressure by the pulmonary artery systolic pressure on invasive hemodynamics, has been shown to predict adverse cardiovascular events in patients with advanced heart failure and pulmonary arterial hypertension. Its prognostic utility in an "all-comers" cohort of patients with right ventricular failure (RVF) has yet to be studied.HypothesisWe hypothesized that PAPP will be strongly associated with mortality and prolonged hospital stay in patients with RVFMethodsWe retrospectively analyzed data on patients admitted in our institution from January 2012 to November 2016 with RVF defined as 1. presence of right ventricular dysfunction on transthoracic echocardiogram 2. cardiac index < 2.2 L/min/m2 3. CVP > 15 and 4. CVP/PCWP > 0.6. Baseline demographic, clinical, laboratory, echocardiographic and hemodynamic data were obtained. Data on inotrope or vasopressor use, need for right ventricular percutaneous mechanical support and length of hospital stay were likewise obtained. Baseline characteristics of patients were compared based on survival at hospital discharge and 6 months thereafter. Categorical variables were reported as frequency or percentage in its group. Continuous variables were characterized using mean and standard deviation.ResultsWe included 47 patients (mean age 62 years, 66% males) majority were African American men with severe left ventricular dysfunction (mean LVEF 30%). Biventricular failure as a consequence of non-ischemic cardiomyopathy was the predominant etiology for the RVF. The total mortality was 32%. PAPP was not independently associated with death (p = 0.374) or length of hospital stay (p=0.81). The clinical, echocardiographic and hemodynamic variables found to be independently associated with increased mortality included right ventricular fractional area change (RV FAC) (p= 0.016), mean arterial pressure (MAP) (p=0.049), right ventricular systolic pressure (RVSP) (p=0.026), inotrope or vasopressor use (p=0.05) and the need for percutaneous right ventricular mechanical support (p= 0.008).ConclusionsIn an “all-comers” cohort of patients with RVF, PAPP was not independently associated with mortality or longer hospital stay. Independent predictors of mortality include a high RV FAC, a low MAP, a low RVSP, inotrope or vasopressor use and the need for percutaneous right ventricular support.