Dynamic Assessment of Pulmonary Artery Pulsatility Index Provides Incremental Risk Assessment for Early Right Ventricular Failure after Left Ventricular Assist Device.

Abstract Background Pulmonary artery pulsatility index (PAPi) has been studied to predict right ventricular failure (RVF) post-LVAD but only as a single time point pre-LVAD. Multiple clinical factors and therapies impact RV function in pre-LVAD patients. Thus, we hypothesized that serial PAPi measurements during cardiac intensive care (CICU) optimization pre-LVAD would provide incremental risk stratification for early RVF post-LVAD. Methods Consecutive patients who underwent sequential pulmonary artery catherization with CICU optimization pre durable-LVAD were included. Serial hemodynamics were retrospectively reviewed across the optimization period. The Optimal PAPi was defined by the initial PAPi + the PAPi at optimized hemodynamics. RVF was defined as need for right ventricular assist device or prolonged inotrope use >14 days post-operatively. Results Patients with early RVF had significantly lower mean Optimal PAPi (3.5 vs 7.5, P Conclusions Optimal PAPi achieved during medical optimization prior to LVAD, provides independent and incremental risk stratification for early RVF, likely identifying dynamic RV reserve.