(571) Low Pulmonary Artery Pulsatility Index (PAPi) Early Post Heart Transplant is Associated with Short Term Outcomes

PurposeRight ventricular (RV) dysfunction is common following heart transplantation and often multifactorial in etiology. It is unclear if the development of RV dysfunction early after transplant is predictive of worse outcomes. Pulmonary arterial pulsatility index (PAPi) is a marker of RV dysfunction shown to predict outcomes in left ventricular assist device patients. To our knowledge, PAPi has not been studied in heart transplantation. We investigated whether PAPi is associated with unfavorable outcomes post heart transplant.MethodsSingle-center, retrospective study of heart transplants performed at our institution from January 2020 to September 2022. We divided our cohort into two groups based on PAPi ≤ or > 1.63 (lowest quartile cutoff). The hemodynamic parameters to calculate PAPi [(pulmonary artery systolic pressure-diastolic pulmonary artery)/right atrial pressure] were obtained from a right heart catheterization (RHC) performed between days 10 and 14. Using T-test, Mann-Whitney-U and Fisher's exact test as appropriate, the groups were compared with regards to baseline characteristics and outcomes. Multivariable logistic regression was used to adjust for confounders.ResultsA total of 226 patients underwent heart transplant from 01/2020 to 9/2022. From those, 204 had data on RHC. The RHC was performed at a mean of 10.8 days (±2.3). PAPi was > 1.63 in 154 patients (75.5%) and 50 (24.5%) had a PAPi ≤ 1.63. Baseline characteristics were similar among the two groups. Among patients with PAPi <1.63, we found a significant difference in days requiring inotropes and length of stay in the intensive care unit (ICU) and the association remained significant after adjusting for confounders in multivariable analysis (Table 1).ConclusionEarly right ventricular dysfunction post heart transplant as measured by PAPi was associated with longer need for inotropes and length of stay in ICU. Further research is warranted to determine long-term implications of a low PAPi. Right ventricular (RV) dysfunction is common following heart transplantation and often multifactorial in etiology. It is unclear if the development of RV dysfunction early after transplant is predictive of worse outcomes. Pulmonary arterial pulsatility index (PAPi) is a marker of RV dysfunction shown to predict outcomes in left ventricular assist device patients. To our knowledge, PAPi has not been studied in heart transplantation. We investigated whether PAPi is associated with unfavorable outcomes post heart transplant. Single-center, retrospective study of heart transplants performed at our institution from January 2020 to September 2022. We divided our cohort into two groups based on PAPi ≤ or > 1.63 (lowest quartile cutoff). The hemodynamic parameters to calculate PAPi [(pulmonary artery systolic pressure-diastolic pulmonary artery)/right atrial pressure] were obtained from a right heart catheterization (RHC) performed between days 10 and 14. Using T-test, Mann-Whitney-U and Fisher's exact test as appropriate, the groups were compared with regards to baseline characteristics and outcomes. Multivariable logistic regression was used to adjust for confounders. A total of 226 patients underwent heart transplant from 01/2020 to 9/2022. From those, 204 had data on RHC. The RHC was performed at a mean of 10.8 days (±2.3). PAPi was > 1.63 in 154 patients (75.5%) and 50 (24.5%) had a PAPi ≤ 1.63. Baseline characteristics were similar among the two groups. Among patients with PAPi <1.63, we found a significant difference in days requiring inotropes and length of stay in the intensive care unit (ICU) and the association remained significant after adjusting for confounders in multivariable analysis (Table 1). Early right ventricular dysfunction post heart transplant as measured by PAPi was associated with longer need for inotropes and length of stay in ICU. Further research is warranted to determine long-term implications of a low PAPi.