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Abstract: SA-PO136

Association of Aortic Pulsatility Index with Clinical Outcomes and In-Hospital eGFR Slope Among Patients Admitted for Acute Decompensated Heart Failure Requiring Hemodynamic Monitoring

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Banlengchit, Run, Tufts Medical Center, Boston, Massachusetts, United States
  • Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
  • Tuttle, Marcelle, Tufts Medical Center, Boston, Massachusetts, United States
  • Moises, Amanda I., Tufts University School of Medicine, Boston, Massachusetts, United States
  • Sarnak, Hannah Leigh, Tufts Medical Center, Boston, Massachusetts, United States
  • Testani, Jeffrey M., Yale School of Medicine, New Haven, Connecticut, United States
  • Oka, Tatsufumi, Tufts Medical Center, Boston, Massachusetts, United States
  • Kiernan, Michael S., Tufts Medical Center, Boston, Massachusetts, United States
  • Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States
  • McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States
Background

Aortic pulsatility index (API), (systolic–diastolic blood pressure)/pulmonary capillary wedge pressure, is a hemodynamic parameter reflecting cardiac contractility and forward perfusion. We examined whether API is associated with mortality, cardiovascular (CV) outcomes and kidney outcomes among patients admitted for acute decompensated heart failure (ADHF).

Methods

For patients admitted for ADHF requiring invasive hemodynamic monitoring from 2015 to 2021, API was calculated at the time of pulmonary artery catheter placement. Mortality and end stage renal disease (ESRD) events were linked to the state death registry and the United States Renal Data System. Heart transplant (HT) and left ventricular assist device (LVAD) implantation events were obtained from the medical record. Cox proportional hazards regression models were used to evaluate the association between API quartiles and a composite endpoint of death, HT, or LVAD. Associations between API and baseline eGFR and in-hospital eGFR slope were evaluated using linear regression and linear mixed models, respectively. Cox proportional hazards regression models were used to evaluate quartiles of API and ESRD.

Results

Among 743 patients, mean (SD) age and baseline eGFR were 62 (14) years, 58 (27) ml/min/1.73m2 respectively. Initial median (IQR) API was 1.8 (1.2, 2.7). Over median follow-up of 23 months, 259 (35%) died, 107 (14%) had HT, and 15 (2%) had LVAD implantation; 62 (8%) developed ESRD. In reference to the quartile with highest API, Quartile 1 (lowest API) was associated with increased risk of the composite outcome of mortality, OHT or LVAD. There was no association between API and baseline eGFR or in-hospital eGFR slope per week (0.42 [-1.69, 2.53]; 0.17 [-0.37, 0.71] per doubling API, respectively), nor any association between quartiles of API with ESRD.

Conclusion

Low API is associated with a higher risk of a composite of death and cardiovascular outcomes but not with baseline or in-hospital eGFR slope or development of ESRD.

Funding

  • NIDDK Support