Pulmonary artery proportional pulse pressure (PAPP) was recently shown to have prognostic value in heart failure (HF) with reduced ejection fraction (HFrEF) and pulmonary hypertension. We tested the hypothesis that PAPP would be predictive of adverse outcomes in patients with implantable pulmonary artery pressure monitor (CardioMEMS™ HF System, St. Jude Medical [now Abbott], Atlanta, GA, USA).
Survival analysis with Cox proportional hazards regression was used to evaluate all-cause deaths and HF hospitalisation (HFH) in CHAMPION trial
1patients who received treatment with the CardioMEMS device based on the PAPP.
Among 550 randomised patients, 274 had PAPP ≤ the median value of 0.583 while 276 had PAPP>0.583. Patients with PAPP≤0.583 (versus PAPP>0.583) had an increased risk of HFH (HR 1.40, 95% CI 1.16–1.68, p=0.0004) and experienced a significant 46% reduction in annualised risk of death with CardioMEMS treatment (HR 0.54, 95% CI 0.31–0.92) during 2–3 years of follow-up. This survival benefit was attributable to the treatment benefit in patients with HFrEF and PAPP≤0.583 (HR 0.50, 95% CI 0.28–0.90, p<0.05). Patients with PAPP>0.583 or HF with preserved EF (HFpEF) had no significant survival benefit with treatment (p>0.05).
Lower PAPP in HFrEF patients with CardioMEMS constitutes a higher mortality risk status. More studies are needed to understand clinical applications of PAPP in implantable pulmonary artery pressure monitors.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Heart, Lung and Circulation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Heart disease and stroke statistics-2017 update: a report from the American Heart Association.Circulation. 2017; 135: e146-e603
- The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.J Am Coll Cardiol. 2014; 63: 1123-1133
- Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.N Engl J Med. 1991; 325: 293-302
- Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF).Lancet. 1999; 353: 2001-2007
- The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.N Engl J Med. 1999; 341: 709-717
- Acute decompensated heart failure: update on new and emerging evidence and directions for future research.J Card Fail. 2013; 19: 371-389
- Trends in heart failure incidence and survival in a community-based population.JAMA. 2004; 292: 344-350
- Molecular epidemiology of heart failure: translational challenges and opportunities.JACC: Basic Transl Sci. 2017; 2: 757-769
- The continuum of personalized cardiovascular medicine: a position paper of the European Society of Cardiology.Eur Heart J. 2014; 35: 3250-3257
- Precision and predictive medicine: lessons learned from our oncology colleagues.JACC Heart Fail. 2014; 2: 671
- Precision medicine for heart failure: lessons from oncology.Circ Heart Fail. 2017; 10
- Coupling between the heart and arterial system in heart failure.Am J Med. 1991; 90: 14S-18S
- Value of right ventricular ejection fraction in predicting short-term prognosis of patients with severe chronic heart failure.J Heart Lung Transplant. 1997; 16: 774-785
- Resynchronization improves heart-arterial coupling reducing arterial load determinants.Europace. 2013; 15: 554-565
- Decreased pulmonary arterial proportional pulse pressure after pulmonary artery catheter optimization for advanced heart failure is associated with adverse clinical outcomes.J Card Fail. 2016; 22: 954-961
- Decreased pulmonary arterial proportional pulse pressure is associated with increased mortality in group 1 pulmonary hypertension.Clin Cardiol. 2017; 40: 988-992
- CHAMPION trial rationale and design: the long-term safety and clinical efficacy of a wireless pulmonary artery pressure monitoring system.J Card Fail. 2011; 17: 3-10
- Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial.Lancet. 2016; 387: 453-461
- Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial.JAMA. 2005; 294: 1625-1633
- Survival in patients with primary pulmonary hypertension. Results from a national prospective registry.Ann Intern Med. 1991; 115: 343-349
- Pulmonary artery pressure-guided management of patients with heart failure and reduced ejection fraction.J Am Coll Cardiol. 2017; 70: 1875-1886
- Interventions linked to decreased heart failure hospitalizations during ambulatory pulmonary artery pressure monitoring.JACC Heart Fail. 2016; 4: 333-344
- Effects of chronically elevated pulmonary arterial pressure and flow on right ventricular afterload.Am J Physiol. 1994; 267: H155-H165
- Impedance and transmission properties of the pulmonary arterial system.Cardiovasc Res. 1971; 5: 1-9
- The relationship between the right ventricle and its load in pulmonary hypertension.J Am Coll Cardiol. 2017; 69: 236-243
- The relationship between the components of pulmonary artery pressure remains constant under all conditions in both health and disease.Chest. 2008; 133: 633-639
- Proportional relations between systolic, diastolic and mean pulmonary artery pressure are explained by vascular properties.Cardiovasc Eng Technol. 2011; 2: 15-23
- Evaluation of pulmonary arterial end-diastolic pressure as an estimate of left ventricular end-diastolic pressure in patients with normal and abnormal left ventricular performance.Circulation. 1971; 44: 1072-1079
- Clinical relevance of right ventricular diastolic stiffness in pulmonary hypertension.Eur Respir J. 2015; 45: 1603-1612
- The effects of exercise on right ventricular contractility and right ventricular-arterial coupling in pulmonary hypertension.Am J Respir Crit Care Med. 2015; 191: 1050-1057
- Prognostic role of pulmonary arterial capacitance in advanced heart failure.Circ Heart Fail. 2012; 5: 778-785
- Intracardiac pressures measured using an implantable hemodynamic monitor: relationship to mortality in patients with chronic heart failure.Circ Heart Fail. 2017; 10
- Tailored therapy to hemodynamic goals for advanced heart failure.Eur J Heart Fail. 1999; 1: 251-257
- Pulmonary arterial capacitance is an important predictor of mortality in heart failure with a preserved ejection fraction.JACC Heart Fail. 2015; 3: 467-474
- Contractile mechanics and interaction of the right and left ventricles.Am J Cardiol. 1981; 47: 686-695
- Mathematic coupling of data: a common source of error.Ann Surg. 1981; 193: 296-303
- Mathematical coupling in medical research: lessons from studies of oxygen kinetics.Br J Anaesth. 1998; 81: 118-120
- Pulmonary vascular resistance and compliance relationship in pulmonary hypertension.Eur Respir J. 2015; 46: 1178-1189
Published online: April 13, 2021
Accepted: March 7, 2021
Received in revised form: December 29, 2020
Received: July 17, 2020
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.