Pulmonary artery pulsatility index (PAPi) can predict mortality in pulmonary arterial hypertension (PAH), according to a new study by researchers in Singapore. It could therefore be a valuable marker for risk stratification. 

Accurate risk prediction is critical for guiding treatment decisions in PAH, so the scientific community has been increasingly focusing on risk stratification models to be able to predict outcomes in PAH patients.

To this aim, Yinghao Lim MBBS, MMed, and the co-authors of the present study identified PAPi as a potential new preditor of mortality in PAH. PAPi is defined as systolic pulmonary artery pressure minus diastolic pulmonary artery pressure over central venous pressure.

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The researchers used data from their standing PAH registry of 14 years (between January 2003 and December 2016) to calculate the PAPi of 102 patients. A third (33%) of these patients had idiopathic PAH, 31% had connective tissue disease, 24% had congenital heart disease, and 12% had other diseases. The mean age of the patients was 53 years and 77% of them were women.

The patients who had low PAPi (below 5.3) were older, had lower pulmonary artery systolic pressure, and higher mean right atrial pressure, compared to those with high PAPi. The mortality risk was calculated to be higher in the low PAPi group than in the high PAPi group.

When the researchers analyzed components of PAPi, they found that mean right atrial pressure was the strongest predictor of mortality.

“In our analysis, low PAPi was found to be a significant but modest independent predictor for death and time to death,” the researchers concluded.

One limitation of the study is that the findings are based on a retrospective analysis of a cohort of PAH patients prospectively enrolled into the PAH registry, which may not reflect current phenotypes or take into consideration the latest advances in PAH therapy.

Future studies should examine whether PAPi could add incremental value to current models of clinical risk prediction, the study authors wrote.


Lim Y, Low TT, Chan SP, et al. Does pulmonary artery pulsatility index predict mortality in pulmonary arterial hypertension? ESC Heart Fail. Published online June 24, 2021. doi:10.1002/ehf2.13450.