Pulmonary artery pulsatility index and adverse outcomes in patients with chronic obstructive pulmonary disease.

INTRODUCTION Pulmonary hypertension (pH) is a recognized complication of chronic obstructive pulmonary disease (COPD), in which right ventricular (RV) dysfunction is associated with worse outcomes. The prognostic value of the pulmonary artery pulsatility index (PAPi), a load-dependent surrogate of RV performance, remains unclear in COPD.

Method

We performed a single-center retrospective cohort study of patients with COPD who underwent right heart catheterization (RHC) between January 2018 and December 2023. The primary outcome was a composite of all-cause mortality and heart failure hospitalizations. Data were stratified into PAPi tertiles, and outcomes were compared using Cox proportional hazards models, adjusted for demographics, comorbidities, and surrogates of COPD and pH severity.

Results

Among 224 patients, 50% were female, 75% African American, and 81% had pH. Median (ranges) PAPi values in the high, intermediate, and low tertiles were 8.1 (4.7-90), 3 (2.3-4.7), and 1.6 (0.5-2.3), respectively. Patients with low PAPi had higher mean and diastolic pulmonary artery pressures, as well as left- and right-sided filling pressures on RHC. On echocardiography, those with low PAPi had lower left ventricular systolic function and more RV strain. Compared with high PAPi, low PAPi was associated with higher risk of the composite outcome (unadjusted model: hazard ratio [HR]=2.36 [95% CI 1.34-4.17], p-value=0.003; adjusted model: HR=2.65 [95% CI 1.42-4.92]; p-value=0.002).

Conclusion

Lower PAPi may identify patients with COPD at increased risk of adverse outcomes. Future studies are needed to validate our study findings in different COPD cohorts and explore optimal PAPi cutoffs.