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Aortic pulsatility index predicts clinical outcomes in heart failure: a sub‐analysis of the ESCAPE trial

AIMS: Aortic pulsatility index (API), calculated as (systolic–diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP), is a novel haemodynamic measurement representing both cardiac filling pressures and contractility. We hypothesized that API would better predict clinical outcomes than t...

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Autores principales: Belkin, Mark N., Alenghat, Francis J., Besser, Stephanie A., Nguyen, Ann B., Chung, Ben B., Smith, Bryan A., Kalantari, Sara, Sarswat, Nitasha, Blair, John E.A., Kim, Gene H., Pinney, Sean P., Grinstein, Jonathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006667/
https://www.ncbi.nlm.nih.gov/pubmed/33595923
http://dx.doi.org/10.1002/ehf2.13246
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author Belkin, Mark N.
Alenghat, Francis J.
Besser, Stephanie A.
Nguyen, Ann B.
Chung, Ben B.
Smith, Bryan A.
Kalantari, Sara
Sarswat, Nitasha
Blair, John E.A.
Kim, Gene H.
Pinney, Sean P.
Grinstein, Jonathan
author_facet Belkin, Mark N.
Alenghat, Francis J.
Besser, Stephanie A.
Nguyen, Ann B.
Chung, Ben B.
Smith, Bryan A.
Kalantari, Sara
Sarswat, Nitasha
Blair, John E.A.
Kim, Gene H.
Pinney, Sean P.
Grinstein, Jonathan
author_sort Belkin, Mark N.
collection PubMed
description AIMS: Aortic pulsatility index (API), calculated as (systolic–diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP), is a novel haemodynamic measurement representing both cardiac filling pressures and contractility. We hypothesized that API would better predict clinical outcomes than traditional haemodynamic metrics of cardiac function. METHODS AND RESULTS: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial individual‐level data were used. Routine haemodynamic measurements, including Fick cardiac index (CI), and the advanced haemodynamic metrics of API, cardiac power output (CPO), and pulmonary artery pulsatility index (PAPI) were calculated after final haemodynamic‐monitored optimization. The primary outcome was a composite endpoint of death or need for orthotopic heart transplant (OHT) or left ventricular assist device (LVAD) at 6 months. A total of 433 participants were enrolled in the ESCAPE trial of which 145 had final haemodynamic data. Final API measurements predicted the primary outcome, OR 0.47 (95% CI 0.32–0.70, P < 0.001), while CI, CPO, and PAPI did not. Receiver operator characteristic analyses of final advanced haemodynamic measurements indicated API best predicted the primary outcome with a cutoff of 2.9 (sensitivity 76.2%, specificity 55.3%, correctly classified 61.4%, area‐under‐the‐curve 0.71), compared with CPO, CI, and PAPI. Kaplan–Meier analyses indicated API ≥ 2.9 was associated with greater freedom from the primary outcome (83.5%), compared with API < 2.9 (58.4%), P = 0.001. While PAPI was also significantly associated, CI and CPO were not. CONCLUSIONS: The novel haemodynamic measurement API better predicted clinical outcomes in the ESCAPE trial when compared with traditional invasive haemodynamic metrics of cardiac function.
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spelling pubmed-80066672021-04-01 Aortic pulsatility index predicts clinical outcomes in heart failure: a sub‐analysis of the ESCAPE trial Belkin, Mark N. Alenghat, Francis J. Besser, Stephanie A. Nguyen, Ann B. Chung, Ben B. Smith, Bryan A. Kalantari, Sara Sarswat, Nitasha Blair, John E.A. Kim, Gene H. Pinney, Sean P. Grinstein, Jonathan ESC Heart Fail Original Research Articles AIMS: Aortic pulsatility index (API), calculated as (systolic–diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP), is a novel haemodynamic measurement representing both cardiac filling pressures and contractility. We hypothesized that API would better predict clinical outcomes than traditional haemodynamic metrics of cardiac function. METHODS AND RESULTS: The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial individual‐level data were used. Routine haemodynamic measurements, including Fick cardiac index (CI), and the advanced haemodynamic metrics of API, cardiac power output (CPO), and pulmonary artery pulsatility index (PAPI) were calculated after final haemodynamic‐monitored optimization. The primary outcome was a composite endpoint of death or need for orthotopic heart transplant (OHT) or left ventricular assist device (LVAD) at 6 months. A total of 433 participants were enrolled in the ESCAPE trial of which 145 had final haemodynamic data. Final API measurements predicted the primary outcome, OR 0.47 (95% CI 0.32–0.70, P < 0.001), while CI, CPO, and PAPI did not. Receiver operator characteristic analyses of final advanced haemodynamic measurements indicated API best predicted the primary outcome with a cutoff of 2.9 (sensitivity 76.2%, specificity 55.3%, correctly classified 61.4%, area‐under‐the‐curve 0.71), compared with CPO, CI, and PAPI. Kaplan–Meier analyses indicated API ≥ 2.9 was associated with greater freedom from the primary outcome (83.5%), compared with API < 2.9 (58.4%), P = 0.001. While PAPI was also significantly associated, CI and CPO were not. CONCLUSIONS: The novel haemodynamic measurement API better predicted clinical outcomes in the ESCAPE trial when compared with traditional invasive haemodynamic metrics of cardiac function. John Wiley and Sons Inc. 2021-02-17 /pmc/articles/PMC8006667/ /pubmed/33595923 http://dx.doi.org/10.1002/ehf2.13246 Text en © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research Articles
Belkin, Mark N.
Alenghat, Francis J.
Besser, Stephanie A.
Nguyen, Ann B.
Chung, Ben B.
Smith, Bryan A.
Kalantari, Sara
Sarswat, Nitasha
Blair, John E.A.
Kim, Gene H.
Pinney, Sean P.
Grinstein, Jonathan
Aortic pulsatility index predicts clinical outcomes in heart failure: a sub‐analysis of the ESCAPE trial
title Aortic pulsatility index predicts clinical outcomes in heart failure: a sub‐analysis of the ESCAPE trial
title_full Aortic pulsatility index predicts clinical outcomes in heart failure: a sub‐analysis of the ESCAPE trial
title_fullStr Aortic pulsatility index predicts clinical outcomes in heart failure: a sub‐analysis of the ESCAPE trial
title_full_unstemmed Aortic pulsatility index predicts clinical outcomes in heart failure: a sub‐analysis of the ESCAPE trial
title_short Aortic pulsatility index predicts clinical outcomes in heart failure: a sub‐analysis of the ESCAPE trial
title_sort aortic pulsatility index predicts clinical outcomes in heart failure: a sub‐analysis of the escape trial
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006667/
https://www.ncbi.nlm.nih.gov/pubmed/33595923
http://dx.doi.org/10.1002/ehf2.13246
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