Increased Pulmonary-Systemic Pressure Ratio is Associated with Adverse Events in Advanced Heart Failure:
Introduction: Concomitant presence of pulmonary hypertension in heart failure (HF) is associated with increased adverse events and may be related to interventricular uncoupling and impaired cardiac efficiency.
Hypothesis: In patients treated for acute decompensated HF, an increased mean pulmonary artery pressure (MPAP) to mean arterial pressure (MAP) ratio (MPS ratio) would be associated with worse clinical outcomes.
Methods: Using Cox proportional hazards regression analysis of patients enrolled in the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial, we evaluated associations between the MPS ratio at discharge and clinical outcomes, including time to death, transplant or left ventricular assist device [LVAD], (DTxLVAD) and time to death, transplant, LVAD or heart failure rehospitalization (DTxLVADHF) over 6 months.
Results: Among 162 patients with complete data (mean age 56.6 ± 13.8 years, 29.0% female), the MPAP, MAP, and MPS ratio were 29.9 ± 9.3 mm Hg, 74.5 ± 11.0 mm Hg, and 0.40 ± 0.14, respectively. The MPS ratio was strongly associated with the outcome of DTxLVAD over 6 months (HR 1.48 per 0.10 increase in the MPS ratio, 95% CI 1.23-1.78, chi square 16.8, P<0.0001). There was also a significant association between the MPS ratio and the outcome of DTXLVADHF during follow-up (HR 1.15 per 0.10 increase in the MPS ratio, 95% CI 1.003-1.31, chi square 4.0, P=0.04). Patients with an MPS ratio above the mean (> 0.40) had a greater incidence of DTxLVAD than patients with an MPS ratio less than or equal 0.40 (Log-Rank P=0.0002) (Figure).
Conclusion: The MPS ratio, a marker of interventricular coupling and efficiency, was independently associated with adverse events in acute decompensated heart failure. Further studies are needed on the wider application of MPS in heart failure.