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Abstract
Background: Right heart failure is a major complication following left ventricular assist device (LVAD) implantation. Pulmonary artery pulsatility index (PAPi) has been evaluated as a haemodynamic marker for right heart failure, but PAPi is dependent on pulmonary vascular resistance. We conducted a systematic review to assess the relationship between PAPi and right heart failure and death in patients undergoing LVAD implantation; and examined the relationship between PAPi cut-off and pulmonary vascular resistance.
Methods: We searched PubMed, EMBASE, CENTRAL and manually screened retrieved references to identify all clinical studies reporting PAPi in adult patients with a durable LVAD. Eligibility criteria were prespecified and two reviewers independently screened and extracted data; the Newcastle-Ottawa Scale was used to assess quality of non-randomized studies. This study was prospectively registered on PROSPERO (CRD42021259009).
Results: From 283 unique records, we identified 16 studies reporting haemodynamic assessment in 20,634 adult patients with an implanted durable LVAD. Only 2 studies reported on mortality and in both, a lower PAPi was significantly associated with death. Fifteen studies reported right heart failure data and in ten studies a lower PAPi was significantly associated with right heart failure. Six studies reported on PAPi cut-offs ranging from 0.88 to 3.3; and the cut-offs were directly related to pulmonary vascular resistance (r = 0.6613, p = 0.019).
Conclusions: Lower PAPi was associated with right heart failure and death following LVAD implantation, but a single PAPi cut-off cannot be defined, as it is dependent on pulmonary vascular resistance.
Methods: We searched PubMed, EMBASE, CENTRAL and manually screened retrieved references to identify all clinical studies reporting PAPi in adult patients with a durable LVAD. Eligibility criteria were prespecified and two reviewers independently screened and extracted data; the Newcastle-Ottawa Scale was used to assess quality of non-randomized studies. This study was prospectively registered on PROSPERO (CRD42021259009).
Results: From 283 unique records, we identified 16 studies reporting haemodynamic assessment in 20,634 adult patients with an implanted durable LVAD. Only 2 studies reported on mortality and in both, a lower PAPi was significantly associated with death. Fifteen studies reported right heart failure data and in ten studies a lower PAPi was significantly associated with right heart failure. Six studies reported on PAPi cut-offs ranging from 0.88 to 3.3; and the cut-offs were directly related to pulmonary vascular resistance (r = 0.6613, p = 0.019).
Conclusions: Lower PAPi was associated with right heart failure and death following LVAD implantation, but a single PAPi cut-off cannot be defined, as it is dependent on pulmonary vascular resistance.
Original language | English |
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Article number | ivad068 |
Number of pages | 10 |
Journal | Interdisciplinary CardioVascular and Thoracic Surgery |
Volume | 36 |
Issue number | 5 |
DOIs | |
Publication status | Published - 12 May 2023 |
Bibliographical note
Funding:This study was funded by a Novel and Emerging Technologies grant from Heart Research UK (NET31/19). Nigel E. Drury was funded by an Intermediate Clinical Research Fellowship from the British Heart Foundation (FS/15/49/31612).
Keywords
- Left ventricular assist device
- Heart failure
- Right heart failure
- Pulmonary artery pulsatility index
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