Hemodynamic integration of pulmonary artery pulsatility index and compliance for risk stratification in patients with heart failure with reduced ejection fraction

Background Right ventricular dysfunction (RVD) and right ventricular (RV) afterload are recognized prognostic factors in patients with heart failure with reduced ejection fraction (HFrEF). Hemodynamic phenotyping based on RVD and RV afterload may help identify clinically meaningful subgroups within the HFrEF population. This study aimed to investigate the prognostic associations of pulmonary artery pulsatility index (PAPi) and pulmonary arterial capacitance (PAC) in patients with HFrEF. Methods and results We retrospectively analyzed a cohort of 156 patients with HFrEF who underwent right heart catheterization. Patients were categorized into four groups based on median PAPi and PAC values. The primary endpoint was a composite of cardiovascular death or heart failure-related hospitalization over a median follow-up of 2.9 years. Kaplan–Meier analysis demonstrated a significant difference in event-free survival across the groups. In multivariate Cox proportional analysis, patients with low PAPi and PAC had significantly worse outcomes than those with high values. Incorporating PAPi and PAC values into the Meta-analysis Global Group in Chronic Heart Failure risk score enhanced the prognostic value of the C-index from 0.658 to 0.703, with a ΔC-index of 0.045. Conclusion Combining PAPi and PAC provides additional prognostic value in patients with HFrEF. Incorporating these parameters into clinical assessment may enhance risk stratification and guide future phenotype-specific therapeutic strategies.