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Aortic Pulsatility Index Predicts Native Recovery in Patients With Cardiogenic Shock Supported by Intra-aortic

Kaneez Zainab1, Eric Taylor1, Nikhil Gangasani1

  • 1Medical University of South Carolina, Charleston, SC.

Journal of Cardiac Failure
|November 13, 2025
PubMed

Insights

A new hemodynamic marker, the assisted aortic pulsatility index (API), predicts native heart recovery in cardiogenic shock patients treated with an intra-aortic balloon pump (IABP). This finding aids in managing patients with severe heart failure.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Biomedical Engineering

Background:

  • The intra-aortic balloon pump (IABP) is a standard therapy for cardiogenic shock (CS).
  • Validated clinical markers for predicting native heart recovery in CS patients on IABP support are lacking.
  • Identifying predictors of native recovery is crucial for optimizing treatment strategies and patient outcomes.

Purpose of the Study:

  • To evaluate clinical and hemodynamic predictors of survival to hospital discharge with native heart recovery in CS patients requiring IABP.
  • To introduce and validate a novel hemodynamic marker, the assisted aortic pulsatility index (API), for predicting native recovery.

Main Methods:

  • Retrospective analysis of 267 consecutive CS patients requiring IABP support between January 2021 and November 2024.
  • Hemodynamic variables, including assisted systolic blood pressure, assisted diastolic blood pressure, and pulmonary capillary wedge pressure (PCWP), were recorded at baseline, initial IABP support, and final IABP support.
  • The assisted aortic pulsatility index (API) was defined as (assisted systolic blood pressure - assisted diastolic blood pressure) / PCWP.

Main Results:

  • Eighty patients were included in the final analysis; in-hospital mortality was 31%.
  • Native recovery occurred in 40% of patients, while 29% were bridged to advanced therapies (transplant or LVAD).
  • Multivariable analysis identified final assisted API (OR 3.283, P=0.002) and acute myocardial infarction (AMI) presentation (OR 18.12, P=0.016) as significant predictors of native recovery.
  • A receiver-operating characteristic curve analysis showed the final assisted API to be a strong predictor (C-statistic: 0.77, P < 0.001).
  • An assisted API cutoff > 1.7 demonstrated 81% sensitivity and 64% specificity for predicting survival to native recovery.

Conclusions:

  • The assisted aortic pulsatility index (API) is a novel, sensitive, and specific hemodynamic marker for predicting native recovery in CS patients supported by IABPs.
  • This marker can aid clinicians in assessing the potential for native heart function recovery and guiding therapeutic decisions.
Abstract

Keywords:
Hemodynamicsacute mechanical circulatory supportcardiogenic shockheart failure

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