Usefulness of Pulmonary Artery Pulsatility Index in Predicting Acute Kidney Injury Following Continuous-Flow Left Ventricular Assist Device Implantation in Ambulatory Advanced Heart Failure Patients

Background: Acute kidney injury (AKI) is a frequent and serious complication after the implantation of continuous-flow left ventricular assist devices (CF-LVADs), often mediated by right ventricular (RV) dysfunction, systemic venous congestion, and subsequent suboptimal device filling. The pulmonary artery pulsatility index (PAPi) is a hemodynamic parameter reflecting RV function. This study evaluated the predictive value of preoperative PAPi for postoperative AKI in ambulatory advanced heart failure patients. Methods: A total of 121 stable, ambulatory advanced heart failure patients (INTERMACS profiles 4–6) who underwent CF-LVAD implantation between 2020 and 2024 were retrospectively analyzed. Preoperative demographic, clinical, and invasive hemodynamic parameters were collected. Postoperative AKI was defined using serum creatinine criteria according to the RIFLE consensus during the first two postoperative days. Results: Postoperative AKI developed in 43 patients (35.5%). The mean PAPi value was significantly lower in the AKI group compared with the non-AKI group (1.4 ± 0.4 vs. 3.2 ± 1.2, p = 0.001). Preoperative right atrial pressure (RAP) was significantly higher in patients who developed AKI. Receiver operating characteristic (ROC) curve analysis demonstrated modest discrimination, with an area under the curve (AUC) of 0.62 (95% CI: 0.52–0.73). A PAPi cut-off value of 2.1 yielded a sensitivity of 0.82 and a specificity of 0.42. Conclusions: In ambulatory advanced heart failure patients undergoing CF-LVAD implantation, a preoperative PAPi value below 2.1 shows an association with a higher risk of postoperative AKI. However, given its modest independent discriminative capacity (AUC 0.62) and potential dependence on venous congestion metrics like RAP, these preliminary findings should be considered exploratory and hypothesis-generating, warranting further external validation in broader cohorts.