Change in Systemic Arterial Pulsatility index (SAPi) during heart failure hospitalization is associated with improved outcomes

Study objective: To identify Change in Systemic Arterial Pulsatitlity index (ASAPi) as a novel hemodynamic marker associated with outcomes in heart failure (HF).Design: The ESCAPE trial was a randomized controlled trial.Setting: The ESCAPE trial was conducted at 26 sites.Participants: 134 patients were analyzed (mean age 56.8 +/- 13.4 years, 29 % female). Interventions: We evaluated the change in SAPi, (systemic pulse pressure/pulmonary artery wedge pressure) obtained at baseline and at the final hemodynamic measurement in the ESCAPE trial.Main outcome measures: Change in SAPi, (ASAPi), was analyzed for the primary outcomes of death, heart transplant, left ventricular assist device (DTxLVAD) or hospitalization, (DTxLVADHF) and secondary outcome of DTxLVAD using Cox proportional hazards regression.Results: Median change in SAPi was 0.81 (IQR 0.20-1.68). ASAPi in uppermost quartile was associated with reductions in DTxLVADHF (HR 0.55 [95 % CI 0.32, 0.93]). ASAPi in the uppermost and lowermost quartiles combined was similarly associated with significant reductions in DTxLVADHF (HR 0.62 [95 % CI 0.41, 0.94]). ASAPi higher than 1.17 was associated with improved DTxLVADHF. ASAPi was also associated with troponin levels at discharge (regression coefficient p = 0.001) and trended with 6-minute walk at discharge (Spearman correlation r = 0.179, p = 0.058).Conclusion: ASAPi was strongly associated with improved HF clinical profile and adverse outcomes. These findings support further exploration of A SAPi in the risk stratification of HF.