Background
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).
Methods
Survival analysis with Cox proportional hazards regression was used to evaluate all-cause
deaths and HF hospitalisation (HFH) in CHAMPION trial
patients who received treatment with the CardioMEMS device based on the PAPP.
Results
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).
Conclusion
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.
Keywords
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Article info
Publication history
Published online: April 13, 2021
Accepted:
March 7,
2021
Received in revised form:
December 29,
2020
Received:
July 17,
2020
Identification
Copyright
© 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.
