One of the predictors of right ventricular failure after inferior myocardial infarction and left ventricular assist device implantation was the pulmonary artery pulsatility index (PAPi). The researchers determined it from the ratio of the pulmonary artery pulse pressure to the pressure of the right atrium. They remained unaware if a link between PAPi and unfavorable outcomes across a heterogeneous population existed. Back-to-back patients going through right heart catheterization between 2005 and 2016 were examined in a hospital-based cohort. The researchers used multivariable Cox models to assess the link between PAPi and major adverse cardiac events, all-cause mortality, and heart failure hospitalizations. The study included 8,285 people (mean age of 63 years, 39% female) with median PAPi across the quartiles 1.7, 2.8, 4.2, and 8.7. These patients were followed over a mean follow-up of 6.7, plus or minus 3.3 years. In the lowest PAPi quartile, the patients had a 60% higher risk of death in comparison to those in the highest quartile (multivariable-adjusted danger ratio, 1.60 [95% CI, 1.36–1.88], P<0.001), as well as a higher risk of heart failure hospitalizations and major adverse cardiac events (danger ratio, 2.08 [95% CI, 1.76–2.47], P<0.001 and danger ratio, 1.80 [95% CI, 1.56–2.07], P<0.001 respectively). Notably, there was a greater risk of cardiovascular events for patients in quartiles 2 and 3 than those in quartile 4 (multivariable P<0.05 for all).

A greater risk of major adverse cardiac events, all-cause mortality, and heart failure hospitalizations were found in patients in PAPi quartiles 1 to 3 where the lowest quartile had the biggest risk. The role of a low PAPi in identifying individuals with high risk across an expansive range of cardiovascular disease, even at higher values than the ones reported before, may be very fundamental.