Background:Right ventricular dysfunction (RVD) in the setting of left ventricular (LV) myocardial damage is a major cause of morbidity and mortality, and the pulmonary artery pulsatility index (PAPi) is a novel hemodynamic index shown to predict RVD in advanced heart failure. However, it is unknown whether PAPi can predict the long-term prognosis of dilated cardiomyopathy (DCM) even in the mild to moderate phase. This study aimed to assess the ability of PAPi to stratify DCM patients without severe symptoms.

Methods and Results:Between April 2000 and March 2018, a total of 162 DCM patients with stable symptoms were evaluated, including PAPi, and followed up for a median of 4.91 years. The mean age was 50.9±12.6 years and the mean LV ejection fraction (EF) was 30.5±8.3%. When divided into 2 groups based on median value of PAPi (low, L-PAPi [<3.06] and high, H-PAPi [≥3.06]), even though there were no differences in B-type natriuretic peptide or pulmonary vascular resistance, the probability of cardiac event survival was significantly higher in the L-PAP than in the H-PAP group by Kaplan-Meier analysis (P=0.018). Furthermore, Cox’s proportional hazard regression analysis revealed that PAPi was an independent predictor of cardiac events (hazard ratio: 0.782, P=0.010).

Conclusions:Even in patients identified with DCM in the mild to moderate phase, PAPi may help stratify DCM and predict cardiac events.

背景：左心室 (LV) 心肌损伤中的右心室功能障碍 (RVD) 是发病率和死亡率的主要原因，而肺动脉搏动指数 (PAPi) 是一种新的血流动力学指数，可预测晚期心力衰竭的 RVD . 然而，PAPi 是否可以预测扩张型心肌病 (DCM) 的长期预后，即使在轻中度阶段也是未知的。本研究旨在评估 PAPi 对无严重症状的 DCM 患者进行分层的能力。

方法和结果： 2000 年 4 月至 2018 年 3 月，共评估了 162 名症状稳定的 DCM 患者，包括 PAPi，中位随访时间为 4.91 年。平均年龄为 50.9±12.6 岁，平均 LV 射血分数 (EF) 为 30.5±8.3%。当根据 PAPi 的中值（低，L-PAPi [<3.06] 和高，H-PAPi [≥3.06]）分为 2 组时，即使 B 型利钠肽或肺血管阻力没有差异，通过 Kaplan-Meier 分析，L-PAP 组的心脏事件存活概率显着高于 H-PAP 组（P=0.018）。此外，Cox 的比例风险回归分析显示 PAPi 是心脏事件的独立预测因子（风险比：0.782，P=0.010）。

结论：即使在轻度至中度阶段确定为 DCM 的患者中，PAPi 也可能有助于对 DCM 进行分层并预测心脏事件。