Peripheral Perfusion Index as a Marker of Hypoperfusion in Heart Failure

Current heart failure (HF) guidelines recommend hemodynamic assessment based on four clinical profiles: dry warm, wet warm, dry cold, and wet cold. While physical examination for signs of congestion, e.g., jugular venous distention, is commonly performed, evaluation of perfusion status is often neglected due to the lack of simple and reliable physical indicators. This study aims to evaluate the perfusion index (PI), a noninvasive parameter derived from the ratio of pulsatile to non-pulsatile blood flow components, as a useful tool for assessing perfusion status in patients with HF.

This prospective study included 257 patients hospitalized for the management of acute HF. Peripheral PI was measured on the index finger before discharge. The presence or absence of a cold perfusion profile was determined using standard clinical criteria. All patients were followed after discharge. The primary outcome was a composite of all-cause mortality and hospitalization for worsening HF.

During a mean follow-up of 446 ± 280 days, 109 patients experienced a primary outcome event. Patients with a cold perfusion profile, as defined by standard criteria, had a higher incidence of the primary outcome (hazard ratio 1.98, 95% confidence interval 1.28-2.91, p < 0.01), as did those with a peripheral PI <1.1 (hazard ratio 2.27, 95% confidence interval 1.55-3.32, p < 0.01). These associations remained consistent across subgroup analyses.

Assessing perfusion status using peripheral PI before discharge may provide a simple and practical method for risk stratification in patients with HF, offering prognostic value comparable to that of a cold perfusion profile determined by standard clinical criteria.