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Pulmonary Artery Pulsatility Index: A Novel Marker for Risk Assessment and Prognosis in Pediatric Idiopathic

Emine Gülşah Torun1, Nevin Özdemiroğlu2, Denizhan Bağrul3

  • 1Department of Pediatric Cardiology, Turkish Ministry of Health, Ankara Bilkent City Hospital, 1604th Street, No: 9, Cankaya/Ankara, 06800, Turkey. drgtorun@gmail.com.

Pediatric Cardiology
|July 27, 2025
PubMed

Insights

The pulmonary artery pulsatility index (PAPi) effectively stratifies risk in pediatric idiopathic pulmonary arterial hypertension (IPAH). Lower PAPi values predict a higher need for invasive interventions, aiding clinical decision-making.

Area of Science:

  • Cardiology
  • Pediatric Pulmonology
  • Medical Diagnostics

Background:

  • Idiopathic pulmonary arterial hypertension (IPAH) in children requires accurate risk stratification.
  • The pulmonary artery pulsatility index (PAPi) is a potential non-invasive marker for right heart function.
  • Predicting the need for invasive intervention in pediatric IPAH is crucial for timely management.

Purpose of the Study:

  • To evaluate the clinical utility of PAPi in risk stratification for pediatric IPAH.
  • To assess PAPi's performance in predicting the necessity of invasive interventions due to severe right heart failure.
  • To establish PAPi as a prognostic marker in pediatric IPAH management.

Main Methods:

  • Retrospective analysis of clinical, echocardiographic, and right heart catheterization data from 24 pediatric IPAH patients.
  • Statistical analyses included ROC curve analysis, Kaplan-Meier survival analysis, and Cox regression.
  • Correlation analysis with functional status (6MWT, WHO-FC) and biomarkers (NT-proBNP).

Main Results:

  • High-risk pediatric IPAH patients exhibited significantly lower PAPi values (p < 0.001).
  • A PAPi cutoff of < 3.24 strongly predicted high-risk status (92% sensitivity, 82% specificity).
  • Lower PAPi independently predicted increased need for invasive interventions (HR 0.36, p=0.042); PAPi > 3.24 correlated with longer event-free survival (p=0.002).

Conclusions:

  • PAPi serves as a reliable prognostic marker for risk stratification in pediatric IPAH.
  • Lower PAPi values are associated with a greater likelihood of requiring invasive interventions.
  • PAPi can aid clinicians in predicting the need for intervention and guiding treatment decisions in pediatric IPAH.

Keywords:
Idiopathic Pulmonary Arterial HypertensionInterventionPediatricsPulmonary Artery Pulsatility IndexRisk Stratification

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