Phenotyping Heart Failure With Preserved Ejection Fraction Using Pulmonary Artery Pulsatility Index and Pulmonary Arterial Capacitance

Background: Right ventricular dysfunction (RVD), driven by right ventricular (RV) afterload, is prognostic in patients with heart failure with preserved ejection fraction (HFpEF). Hemodynamic phenotyping based on RVD and RV afterload may provide useful information for the management of HFpEF. This study investigated the prognostic impacts of the pulmonary artery pulsatility index (PAPi) and pulmonary arterial capacitance (PAC) in patients with HFpEF. Methods and Results: A retrospective cohort of 246 HFpEF patients who underwent right heart catheterization was analyzed. Patients were divided into 4 groups according to the median PAPi and PAC values. The primary endpoint was a composite of all-cause death or heart failure-related hospitalization over a median follow-up of 4.1 years. Kaplan-Meier analysis showed significant stratification of event-free survival among the groups (log-rank P=0.003). Multivariate Cox proportional analysis revealed that patients with low PAPi and PAC exhibited worse outcomes than those with the high PAPi and PAC (hazard ratio 3.205; 95% confidence interval [CI] 1.401–7.330; P=0.006). Incorporating PAPi and PAC values into the MAGGIC risk score improved the C-index from 0.671 to 0.720 (∆C-index 0.050; 95% CI 0.004–0.095; P=0.032). Conclusions: A combination of PAPi and PAC improved prognostic ability in patients with HFpEF. Future investigations into treatments for these new hemodynamic phenotypes may improve clinical outcomes of patients with HFpEF.