Utility Of Echocardiographic-derived Pulmonary Artery Pulsatility Index In Early Right Ventricular Failure Post-lvad Implantation

• Published in: Journal of cardiac failure 2023-04, Vol.29 (4), p.632-633
• Main Authors: Kochar, Kirpal, Vishnevsky, Alec, Marek-Iannucci, Stefanie, Ruge, Max, Zurlo, Claire, Liotta, Mark, Hajduczok, Alexander, Ullah, Waqas, Alvarez, Rene, Brailovsky, Yevgeniy, Rajapreyar, Indranee
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.10.212

Pulmonary artery pulsatility index (PAPi) has previously been described as a marker of right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation. PAPi is calculated from hemodynamics derived from invasive right heart catheterization (RHC), however recently has been derived from non-invasive echocardiographic based hemodynamics with good correlation. This echocardiographic based derivation, however, has not yet been studied in patients with LVADs, particular in patients who developed early RVF. We retrospectively studied patients who underwent implantation of a HeartMate III (HM3) LVAD at our institution between January 2015 and December 2021. We identified patients who developed early RVF based on the following criteria: (1) post-op implantation of a right ventricular assist device (RVAD), (2) continuous requirement of inotropes for greater than 14 days post-op, (3) new initiation of inotropes after post-op day 14, or (4) requirement of inhaled nitric oxide for greater than 2 days post-op. Invasive PAPi (iPAPi) was derived from pre-op RHC, while echo-derived PAPi (ePAPi) was derived from pre-op TTE. ePAPi was calculated as [[4 x (peak TR velocity)2 + RA pressure] - [4 x (end-diastolic pulmonary regurgitant velocity)2 + RA pressure]] / (RA pressure) while a simplified echo-derived PAPi (sPAPi) was calculated as (peak TR pressure) / (RA pressure). Statistical analysis was performed using SPSS. A total of 118 patients were identified who underwent implantation of a HM3 at our institution, of which 50 patients developed early RVF. A total of 20 patients with early RVF and complete pre-implantation RHC and TTE were included and compared to a group of 20 patients who did not develop early RVF. Among patients who developed RVF, there was no significant difference between the iPAPi and ePAPi (2.94 vs 4.42, p=0.21), however there was a poor correlation between both parameters (Pearson R 0.21, p=0.44). Additionally, there was no significant difference in the iPAPi, ePAPi, or sPAPi between the RVF and non-RVF groups. In patients undergoing implantation of a HM3 LVAD, echo-derived PAPi may serve as a non-invasive marker of early RVF to complement RHC-derived PAPi. Additional studies with larger sample sizes are needed to further investigate this modality and correlation with invasive hemodynamics.