Clinical impact of pulmonary artery pulsatility index in patients with atrial fibrillation and heart failure

Background: Both atrial fibrillation (AF) and right ventricular dysfunction (RVD) are prognostic factors in patients with heart failure (HF). However, the association between AF and RVD in patients with HF is not fully understood. The pulmonary artery pulsatility index (PAPi), obtained via right heart catheterisation, is a hemodynamic index of the right ventricular function. We investigated the clinical impact of PAPi in patients with HF and concomitant AF. Methods: This was a single-center, retrospective cohort study involving consecutive patients who underwent right heart catheterisation for HF between January 2016 and December 2018. Patients with acute decompensated phase of HF were excluded. The primary endpoint was a composite of all-cause death or hospitalisation due to HF. Results: A total of 347 patients with compensated HF were enrolled. The median follow-up duration was 3.2 years. Patients with AF had lower PAPi levels compared to those without AF. Multiple regression analysis revealed that AF was independently associated with reduced PAPi levels (partial regression coefficient −0.116, 95% confidence intervals [CIs] − 0.174 to −0.058; p < 0.001). Multivariate Cox regression analysis further revealed that low PAPi was an independent predictor of the incidence of the primary endpoint in patients with HF and AF (HR 1.861, 95% CIs 1.076–3.219, p = 0.026). Conclusion: AF was associated with reduced PAPi levels in patients with HF. Low PAPi independently predicted the prognosis of patients with AF and HF. Measuring PAPi provides useful information for the management of patients with HF and concomitant AF.