Systemic arterial pulsatility index (SAPi) predicts adverse outcomes in advanced heart failure patients

Change in Systemic Arterial Pulsatility Index (SAPi) during Heart Failure Hospitalization is Associated with Improved Outcomes

Study Objective

To identify Change in Systemic Arterial Pulsatitlity index (ΔSAPi) as a novel hemodynamic marker associated with outcomes in heart failure (HF).

Design

The ESCAPE trial was a randomized controlled trial.

Setting

The ESCAPE trial was conducted at 26 sites.

Participants

134 patients were analyzed (mean age 56.8 ± 13.4 years, 29% female).

Interventions

We evaluated the change in SAPi, ([systemic pulse pressure/pulmonary artery wedge pressure) obtained at baseline and at the final hemodynamic measurement in the ESCAPE trial.

Main Outcome Measures

Change in SAPi, (ΔSAPi), was analyzed for the primary outcomes of death, heart transplant, left ventricular assist device (DTxLVAD) or hospitalization, (DTxLVADHF) and secondary outcome of DTxLVAD using Cox proportional hazards regression.

Results

Median change in SAPi was 0.81 (IQR 0.20-1.68). ΔSAPi in uppermost quartile was associated with reductions in DTxLVADHF (HR 0.55 [95% CI 0.32, 0.93]). ΔSAPi in the uppermost and lowermost quartiles combined was similarly associated with significant reductions in DTxLVADHF (HR 0.62 [95% CI 0.41, 0.94]). ΔSAPi higher than 1.17 was associated with improved DTxLVADHF. ΔSAPi was also associated with troponin levels at discharge (regression coefficient p = 0.001) and trended with 6-minute walk at discharge (Spearman correlation r = 0.179, p = 0.058).

Conclusion

ΔSAPi was strongly associated with improved HF clinical profile and adverse outcomes. These findings support further exploration of Δ SAPi in the risk stratification of HF.