Pulmonary Artery Pulsatility Index Response to Vasodilator Challenge Predicts Early Right Ventricular Failure After Left Ventricular Assist Device

Vasodilator challenge during right heart catheterization (RHC), by improving right ventricular (RV) loading conditions, could provide an assessment of RV functional reserve. We hypothesized that a dynamic evaluation of RV function with sodium nitroprusside (NTP) infusion could enhance conventional risk stratification for post-left ventricular assist device (LVAD) early RV failure (RVF). We performed an observational retrospective multicenter study including consecutive LVAD recipients undergoing vasodilator challenge within 3 months from surgery. We evaluated the association of clinical, echocardiographic, and hemodynamic data at baseline and after NTP infusion with post-LVAD early RVF. Of 160 patients, RVF occurred in 58 (36.3%) and was associated with higher in-hospital mortality (32.8% vs. 3.9%, p < 0.001). Among baseline hemodynamics, pulmonary artery pulsatility index (PAPi) <2 was the single variable associated with RVF (p = 0.038). In a multivariable model adjusted for in-study outcome predictors, a blunted PAPi response to vasodilator challenge (PAPi increase <2.2) emerged as the strongest independent RVF predictor (odds ratio [OR] = 4.56, 95% confidence interval [CI] = 1.88-11.07, p = 0.001). Patients with a blunted PAPi response had an increased RVF risk both in the baseline PAPi <2 (61.9% vs. 12.5%, p = 0.022) and in the baseline PAPi ≥2 (40.2% vs. 17.5%, p = 0.004) groups. Vasodilator challenge, by unveiling RV functional reserve, could improve patient selection and optimization before LVAD implant.