Bayram Z, Dogan C, Efe SC, et al. - In patients with end-stage heart failure (ESHF), low pulmonary artery pulsatility index (PAPi) was found to be an independent risk for adverse cardiac event (ACE; defined as left ventricular assist device implantation, urgent heart transplantation, or cardiac mortality) and it was shown to have a linear association with it. However, the right ventricular stroke work index (RVSWI) appeared to have a nonlinear relationship with ACE (J-curve pattern).

• This study included 416 patients with ESHF to determine the prognostic impact of PAPi and RVSWI in these patients.

• A median follow-up of 503.50 days revealed 218 ACE cases and 198 non-ACE cases.

• Lower PAPi and similar RVSWI in ACE patients were evident when compared to those without ACE (3.1±1.9 vs 3.7±2.3, P=0.003 and 7.3±4.9 vs 6.9±4.4, P=0.422, respectively).

• In multivariate analysis, PAPi (from 2 to 5.65) was shown to be linked with ACE, RVSWI (from 3.62 to 9.75) was not related to ACE (HR: 0.75 and 0.79, respectively).

• A higher ACE risk associated with PAPi ≤2.56 was noted vs PAPi >2.56 (HR: 1.46).

• ACE prediction was enabled by PAPi ≤2.56 with 56.7% sensitivity and 51.3% specificity at one year.

• A nonlinear (J-curve pattern) link was evident between RVSWI and ACE.

• Low and high values appeared to be related to higher ACE risk than intermediate values.