PAPP, Measure of Cardiac Health, May Help to Spot Heart Failure Risk

A new metric for assessing cardiac health, called pulmonary artery proportional pulse pressure or PAPP, could help to identify people at high risk of hospitalization or death due to pulmonary hypertension or heart failure, allowing for more timely and effective treatment, a study reported.

Researchers at the University of Virginia (UVA), who developed PAPP, called it a “simple measure” that could be useful in identifying at-risk patients, so doctors might “tailor more aggressive treatments” for them, such as a heart monitor implant, according to a university press release.

The utility of PAPP was described in the study, “Pulmonary Artery Proportional Pulse Pressure (PAPP) Index Identifies Patients With Improved Survival From the CardioMEMS Implantable Pulmonary Artery Pressure Monitor,” published in the journal Heart, Lung and Circulation.

PAPP is calculated based on several blood pressure measurements; in essence, the measure assesses the “stiffness” of the pulmonary arteries that carry blood from the right side of the heart to the lungs.

“The stiffness of the pulmonary arteries determines how much resistance the right side of the heart has overcome to pump blood effectively to the lungs,” Sula Mazimba, MD, the study’s lead author and a professor of cardiovascular medicine at UVA, said in the release.

“In the past, the function of the right chamber of the heart was often ignored and considered to be inconsequential to the overall performance of the heart, but we are now learning that this is not the case,” Mazimba added. “Having tools that signal when the right side of the heart is under strain may aid clinicians to adopt timely tailored treatments for heart-failure patients”

Researchers analyzed data from 550 participants in the CHAMPION clinical trial (NCT00531661). In this study, individuals with pulmonary hypertension or systolic heart failure (in which the heart’s left ventricle is weak) were randomly assigned to either standard treatment, or to an implant with a wireless heart monitor called the CardioMEMS HF System.

Prior research has shown that the CardioMEMS HF System, marketed by Abbott, can predict the risk of heart failure in people with pulmonary arterial hypertension.

The median PAPP value among these 550 people was found to be 0.583 in the trial: 276 patients had a PAPP value higher than the median, and 274 had a value of equal to or less than the median.

Through statistical analyses, the researchers demonstrated that those with a PAPP score of 0.583 or less were at 40% higher risk of heart failure-related hospitalization.

Among those with lower PAPP values, heart monitoring with the CardioMEMS HF System reduced the annual risk of death significantly, by 46% each year over two to three years of follow-up, the researchers reported.

“The implications of this study are highly significant. We now have identified a specific group of patients who appear to have a marked improvement in survival with implantation of these pulmonary artery wireless monitors,” said Kenneth Bilchick, MD, a cardiologist at UVA Health and a study co-author.

Study findings, he said, “could maximize the impact of this technology” for a large number of people potentially at risk.

“This is an excellent example of how secondary analyses of clinical databases maintained by the National Institutes of Health can result in novel and personalized approaches to patient care,” Bilchick added.