Lower Pulmonary Artery Systolic Pressure To Right Atrial Volume Index Ratio Is Associated With Mortality In Pulmonary Hypertension

Introduction There is a growing need for risk stratification of patients with pulmonary hypertension (PH) using non-invasive modalities. We investigated the prognostic value of the echocardiogram-derived index pulmonary artery systolic pressure to right atrial volume index ratio (PASP/RAVi) vs pulmonary artery pulsatility index (PAPi) in patients with PH. Methods We used logistic regression models to evaluate the association between PASP/RAVi and survival. The models used the variables as either continuous or dichotomized by the median. Results Among 121 patients (age 61.8 +/- 12.7 years, 68.6% female), 17 patients (14%) died during follow-up. The median PASP/RAVi was 2.05 (IQR 1.56-2.83) and the median PAPi was 4.0 (IQR 3.0-6.0). In a logistic regression model, patients with PASP/RAVi greater than the median had an OR for death of 0.26 (95% CI 0.07-0.80, p=0.028), and the AUC was 65.2% (95% CI 53.7%-76.6%) (Panel A). The model with PASP/RAVi as a continuous variable (as opposed to dichotomization by the median) also showed improved survival with increasing PASP/RAVi with a trend p-value of​ 0.14 (OR 0.65, 95% CI 0.35-1.08). This was compared to the PAPi, which did not predict survival either as a continuous parameter (p=0.85) or as a median-dichotomized parameter (p=0.65). The corresponding AUC is shown in Panel B. Conclusions Lower PASP/RAVi was associated with increased mortality in patients with PH. This novel non-invasive index may be used as a prognostic indicator.