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Mazimba and colleagues demonstrated that a lower systemic arterial pulsatility index (SAPi), which is calculated as pulse pressure to pulmonary artery wedge pressure (PAWP) ratio, was associated with the incremental incidence of adverse clinical outcomes in patients with heart failure [1]. Several concerns should improve their findings.
Etiologies of heart failure, including ischemic, hypertensive, and valvular diseases, might have a considerable impact on SAPi, whereas no data are displayed in their study [1]. For example, aortic regurgitation is associated with wide pulse pressure. Laboratory and comorbidity data are also missing. A multivariable incorporating these potential confounders on clinical outcomes would increase the statistical robustness of their primary finding: the prognostic impact of SAPi.
One of the limitations of SAPi is the requirement of invasive right heart catheterization to measure pulmonary artery wedge pressure [1]. Our team recently demonstrated a moderate correlation between remote dielectric sensing, non-invasive electromagnetic-based technology to quantify lung fluid amount, and invasively measured PAWP [2]. Do the authors know any alternative non-invasive technology to PAWP?
The next concern would be the change in SAPi during therapeutic interventions. For example, improvement in congestion by diuretics therapy might decrease PAWP and paradoxically increase pulse pressure according to the concept of Frank-Starlin’s law. Heart rate modulation therapy using ivabradine might maximize cardiac output and increase pulse pressure [3].
References
Mazimba S, Mwansa H, Breathett K, Strickling JE, Shah K, McNamara C, Mehta N, Kwon Y, Lamp J, Feng L, Tallaj J, Pamboukian S, Mubanga M, Matharoo J, Lim S, Salerno M, Mwansa V, Bilchick KC (2022) Systemic arterial pulsatility index (SAPi) predicts adverse outcomes in advanced heart failure patients. Heart Vessels 37(10):1719–1727
Imamura T, Hori M, Ueno Y, Narang N, Onoda H, Tanaka S, Nakamura M, Kataoka N, Sobajima M, Fukuda N, Ueno H, Kinugawa K (2022) Association between Lung Fluid Levels Estimated by Remote Dielectric Sensing Values and Invasive Hemodynamic Measurements. J Clin Med 11(5):1208
Izumida T, Imamura T, Nakamura M, Fukuda N, Kinugawa K (2020) How to consider target heart rate in patients with systolic heart failure. ESC Heart Fail 7(5):3231–3234
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Akao, K., Imamura, T. Prognostic implication of systemic arterial pulsatility index in patients with heart failure. Heart Vessels 38, 1092 (2023). https://doi.org/10.1007/s00380-022-02214-9
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DOI: https://doi.org/10.1007/s00380-022-02214-9