Available online 17 September 2022

Pulmonary hypertension (PH) is a progressive pulmonary vascular disorder with elevated mortality risk. Pulmonary artery (PA) pulsatility index (PAPi) based on invasively acquired parameters has emerged as a hemodynamic risk predictor. Whether noninvasively derived PAPi (PA pulse pressure divided by right atrial (RA) pressure) is valuable is unclear.

Consecutive patients undergoing transthoracic echocardiography for known or suspected PH were included with conventional echocardiographic measures of PA systolic, PA diastolic, and estimated RA pressures. In those patients with PH (mean PA pressure > 20 mm Hg), PAPi was divided into 3 groups; <1.5, 1.5 to 3, and >3. Mortality was assessed over 5 years.

Of 1,045 patients enrolled, 64% had PH. Patients with the lowest PAPi had higher NT-proBNP levels, larger right ventricles (RV), worse right heart systolic function and greater degrees of tricuspid regurgitation. In patients with PH, PAPi was inversely proportional to the risk of death, with PAPi <3 associated with a 1.96-fold increased risk of death (95% CI 1.45-2.64, p<.0001). At multivariate analysis, RV longitudinal systolic strain (HR 1.45, 1.24-1.71; p<.0001), PAPi <3 (HR 1.76, 1.31-2.37; p=.0002), and the presence of a pericardial effusion (HR 1.64, 1.20-2.26 p=.003) were independently associated with increased mortality. In age- and sex-adjusted model, PAPi was incremental to PA compliance.

In patients with PH, low PAPi, derived noninvasively by transthoracic echocardiography, is associated with markers of right heart failure, RV dysfunction and worse survival. PAPi could be incorporated into the conventional echo parameters reported in patients with PH and may be a useful predictor of outcome.

2022 Published by Elsevier Inc. on behalf of the American Society of Echocardiography.