Aortic Pulsatility Index: A Novel Hemodynamic Variable for Evaluation of Decompensated Heart Failure
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Section snippets
Methods
This study was approved by the University of Chicago Institutional Review Board. Retrospective data were collected on consecutive patients undergoing RHC at the University of Chicago between January 2013 and November 2019. Patients were retrieved with a coding query via the electronic medical record (Epic 2018, Epic Headquarters, Verona, WI). Included patients had to be 18 years or older and undergoing a milrinone drug study completed by a member of the advanced heart failure team to assess
Baseline
A total of 224 procedures were analyzed from 224 individual patients. At the time of procedure, average age was 57 years (48–66 years), and 33.5% were women, 39.3% Caucasian, and 31.3% had underlying ischemic cardiomyopathy. Patients with continued medical management were more likely to have had a history of stroke at baseline (20.3% vs 8.7%, P = .01). Additional data regarding baseline characteristics and medical regimens can be seen in Table 1. Moderate sedation was used in 103 procedures
Discussion
In this study, we introduce and derive the API, a novel hemodynamic measurement in patients with acute, chronic, and worsening heart failure, which is significantly associated with adverse clinical outcomes. API is associated with advanced therapies or death at 30 days with a reasonable degree of sensitivity and specificity.
The API was designed to simultaneously represent cardiac function and filling pressures. It accomplishes this goal in 2 ways: (1) by clinical intuition, because medical
Limitations
This study is limited by its retrospective nature. Additionally, all RHC evaluations were done by a single group of physicians, which limits interoperator variability, and may decrease the applicability to patients not evaluated in our center. Likewise, a statistical limitation is that the sample size did not provide the ability to validate the ROC cutoff points by splitting the dataset into training and testing datasets; future research would require the testing these cutoff points with new
Conclusions
The API is a novel invasive hemodynamic measurement that is independently associated freedom from advanced therapies or death at 30-day follow-up.
LAY SUMMARY
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The API is a novel metric to assess the severity of illness in a patient heart failure.
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In patients with heart failure, with an API of less than 1.45 was associated with implantation of a left ventricular assist device, heart transplantation, the need for continuous use of vasoactive medications, or temporary mechanical circulatory support
Disclosures
The authors disclose no conflicts.
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