Prognostication Of Pulmonary Artery Pulsatility Index And Pulmonary Capillary Wedge Pressure In Patients Requiring Impella Support

Introduction Pulmonary Artery Pulsatility Index (PaPi) was initially described to identify patients at risk for right ventricular dysfunction after inferior wall myocardial infarctions. The formula has since been applied to patients with advanced heart failure and pulmonary arterial hypertension to predict adverse outcomes. However, there is a lack of data regarding the utility of PaPi in assessing outcomes in patients requiring Impella 2.5 and CP - temporary left ventricular support devices. Hypothesis Lower PaPi and higher PCWP will be associated with increased mortality after Impella placement. Methods All patients admitted to York Hospital requiring Impella support due to cardiogenic shock between January 1, 2018 and May 1, 2020 were included in this retrospective study. Baseline characteristics and in-hospital mortality months were compared for hemodynamic variables including pulmonary capillary wedge pressure (PCWP) and PaPi. These numbers were collected and analyzed after Impella placement, 24 hours later, and the day of removal using ANOVA, logistic regression, and Fisher's exact test. Results There were 32 patients who met inclusion criteria. At time of Impella implantation, the cohort had an average age of 67.6 + 9.9, ejection fraction of 24.62 + 13.09%, brain natriuretic peptide of 772.03 + 1103.8 pg/dL, and lactate of 4.634 + 4.194 mmol/L. The average duration of Impella support was 2.6875 + 1.89 days. Pulmonary artery pulsatility index was strongly associated with in-hospital mortality at values less than 1.2 after Impella placement (p = 0.0325) and on the day of removal (p = 0.0003). Increasing PCWP strongly correlated with in-hospital mortality after Impella placement (p = 0.0179) and on the day of removal (p = 0.0032). Neither PCWP nor PaPi correlated with mortality at 24 hours. Conclusions In patients requiring Impella support for cardiogenic shock, PaPi and PCWP are significant predictors of in-hospital mortality. These variables are strongly associated with mortality after Impella placement and on the day of removal. PaPi is a better predictor of poor outcomes at lower values, as values less than 1.2 strongly correlated with mortality. Increasing PCWP will invariably increase the value of PaPi due to the effects of PCWP on pulmonary artery capacitance. Patients with worsening left ventricular dysfunction will thus have higher values of PaPi. A lower PaPi may be an ominous sign in patients requiring mechanical support, but further studies should be done to further assess its prognostic role. Pulmonary Artery Pulsatility Index (PaPi) was initially described to identify patients at risk for right ventricular dysfunction after inferior wall myocardial infarctions. The formula has since been applied to patients with advanced heart failure and pulmonary arterial hypertension to predict adverse outcomes. However, there is a lack of data regarding the utility of PaPi in assessing outcomes in patients requiring Impella 2.5 and CP - temporary left ventricular support devices. Lower PaPi and higher PCWP will be associated with increased mortality after Impella placement. All patients admitted to York Hospital requiring Impella support due to cardiogenic shock between January 1, 2018 and May 1, 2020 were included in this retrospective study. Baseline characteristics and in-hospital mortality months were compared for hemodynamic variables including pulmonary capillary wedge pressure (PCWP) and PaPi. These numbers were collected and analyzed after Impella placement, 24 hours later, and the day of removal using ANOVA, logistic regression, and Fisher's exact test. There were 32 patients who met inclusion criteria. At time of Impella implantation, the cohort had an average age of 67.6 + 9.9, ejection fraction of 24.62 + 13.09%, brain natriuretic peptide of 772.03 + 1103.8 pg/dL, and lactate of 4.634 + 4.194 mmol/L. The average duration of Impella support was 2.6875 + 1.89 days. Pulmonary artery pulsatility index was strongly associated with in-hospital mortality at values less than 1.2 after Impella placement (p = 0.0325) and on the day of removal (p = 0.0003). Increasing PCWP strongly correlated with in-hospital mortality after Impella placement (p = 0.0179) and on the day of removal (p = 0.0032). Neither PCWP nor PaPi correlated with mortality at 24 hours. In patients requiring Impella support for cardiogenic shock, PaPi and PCWP are significant predictors of in-hospital mortality. These variables are strongly associated with mortality after Impella placement and on the day of removal. PaPi is a better predictor of poor outcomes at lower values, as values less than 1.2 strongly correlated with mortality. Increasing PCWP will invariably increase the value of PaPi due to the effects of PCWP on pulmonary artery capacitance. Patients with worsening left ventricular dysfunction will thus have higher values of PaPi. A lower PaPi may be an ominous sign in patients requiring mechanical support, but further studies should be done to further assess its prognostic role.