Laura A. Rechsteiner, Lukas Weber, Philipp K. Haager, Johannes Rigger, Joannis Chronis, Peter Ammann, Roman Brenner, Martin O. Schmiady, Hans Rickli, Micha T. Maeder
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We sought to assess the prognostic impact of the PAPi in unselected patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We studied consecutive patients with severe AS (<i>n</i> = 487, 74 ± 10 years, 58% males) undergoing right heart catheterization prior to AVR with post-AVR follow-up of several years.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The mean PAPi was 4.7 ± 3.3, and the mean values in the four PAPi quartiles were 2.1 ± 0.5, 3.2 ± 0.3, 4.5 ± 0.5 and 8.9 ± 4.2. Patients in the lowest PAPi quartile had similar AS severity, symptoms, B-type natriuretic peptide and surgical risk compared with patients in higher quartiles. The lowest PAPi quartile had the lowest PAPP and the highest mRAP and only a slightly reduced stroke volume index (SVI) but the highest pulmonary artery capacitance (PAC). After a median post-AVR follow-up of 45 months mortality did not differ across PAPi quartiles (log rank <i>P</i> = 0.50), which was independent of the AVR mode. However, all contributors of the PAPi equation, that is, higher PAPP, lower PAC (i.e., stroke volume divided by PAPP), lower SVI and higher mRAP were associated with increased mortality.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>In unselected patients with severe AS, the PAPi did not predict post-AVR mortality. This may be explained by the fact that the low PAPP in those with low PAPi was mainly a reflection of a high PAC rather than a low SVI.</p>\n </section>\n </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3483-3493"},"PeriodicalIF":3.7000,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15378","citationCount":"0","resultStr":"{\"title\":\"The pulmonary artery pulsatility index in patients with severe aortic stenosis undergoing valve replacement\",\"authors\":\"Laura A. Rechsteiner, Lukas Weber, Philipp K. Haager, Johannes Rigger, Joannis Chronis, Peter Ammann, Roman Brenner, Martin O. Schmiady, Hans Rickli, Micha T. 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引用次数: 0
摘要
背景与目的:肺动脉搏动指数(PAPi),即肺动脉脉冲压(PAPP)除以平均右心房压(mRAP),是一种越来越被使用的有创性右心室功能指标。我们试图评估PAPi对接受主动脉瓣置换术(AVR)的主动脉瓣狭窄(AS)患者的预后影响。方法:我们研究了严重AS患者(n = 487, 74±10岁,58%男性)在AVR前接受右心导管插入术,AVR后随访数年。结果:PAPi平均值为4.7±3.3,四个四分位数的平均值分别为2.1±0.5、3.2±0.3、4.5±0.5和8.9±4.2。PAPi最低四分位数的患者与较高四分位数的患者相比,AS严重程度、症状、b型利钠肽和手术风险相似。PAPi最低的四分位数有最低的PAPi和最高的mRAP,只有轻微降低的脑卒中容量指数(SVI),但最高的肺动脉电容(PAC)。在AVR后随访45个月后,死亡率在PAPi四分位数之间没有差异(log rank P = 0.50),这与AVR模式无关。然而,PAPi方程的所有因素,即较高的PAPP、较低的PAC(即卒中容量除以PAPP)、较低的SVI和较高的mRAP均与死亡率增加相关。结论:在未选择的严重AS患者中,PAPi不能预测avr后的死亡率。这可能是由于低PAPi的低PAPP主要反映了高PAC而不是低SVI。
The pulmonary artery pulsatility index in patients with severe aortic stenosis undergoing valve replacement
Background and aims
The pulmonary artery pulsatility index (PAPi), that is, the pulmonary artery pulse pressure (PAPP) divided by the mean right atrial pressure (mRAP), is an increasingly used invasive index of right ventricular function. We sought to assess the prognostic impact of the PAPi in unselected patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR).
Methods
We studied consecutive patients with severe AS (n = 487, 74 ± 10 years, 58% males) undergoing right heart catheterization prior to AVR with post-AVR follow-up of several years.
Results
The mean PAPi was 4.7 ± 3.3, and the mean values in the four PAPi quartiles were 2.1 ± 0.5, 3.2 ± 0.3, 4.5 ± 0.5 and 8.9 ± 4.2. Patients in the lowest PAPi quartile had similar AS severity, symptoms, B-type natriuretic peptide and surgical risk compared with patients in higher quartiles. The lowest PAPi quartile had the lowest PAPP and the highest mRAP and only a slightly reduced stroke volume index (SVI) but the highest pulmonary artery capacitance (PAC). After a median post-AVR follow-up of 45 months mortality did not differ across PAPi quartiles (log rank P = 0.50), which was independent of the AVR mode. However, all contributors of the PAPi equation, that is, higher PAPP, lower PAC (i.e., stroke volume divided by PAPP), lower SVI and higher mRAP were associated with increased mortality.
Conclusions
In unselected patients with severe AS, the PAPi did not predict post-AVR mortality. This may be explained by the fact that the low PAPP in those with low PAPi was mainly a reflection of a high PAC rather than a low SVI.
期刊介绍:
ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.