A Systematic Review and Physiology of Pulmonary Artery Pulsatility Index in Left Ventricular Assist Device Therapy

Ivan Yim, Ayisha M Khan-Kheil, Nigel Drury, Hoong Lim*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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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.
Original languageEnglish
Article numberivad068
Number of pages10
JournalInterdisciplinary CardioVascular and Thoracic Surgery
Volume36
Issue number5
DOIs
Publication statusPublished - 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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