Right ventricular dysfunction (RVD) and afterload play an important prognostic role in heart failure with reduced ejection fraction (HFrEF), yet their combined effect has remained underexplored. A retrospective cohort study, published in the European Journal of Heart Failure, evaluated the prognostic value of the pulmonary artery pulsatility index (PAPi) and pulmonary arterial capacitance (PAC) in patients with HFrEF.

The analysis included 156 patients with HFrEF who underwent right heart catheterization. Patients were categorized into four subgroups according to median PAPi and PAC values. Over a median follow-up of 2.9 years, Kaplan–Meier analysis showed significant differences in event-free survival across the groups. Patients with low PAPi and low PAC had the poorest outcomes, with a higher risk of cardiovascular death or heart failure hospitalization. Adding PAPi and PAC to the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) risk score improved the prognostic accuracy, raising the C-index from 0.658 to 0.703 (ΔC-index 0.045).

The study concluded that integrating PAPi and PAC into hemodynamic assessment may improve risk stratification and inform phenotype-specific management strategies in HFrEF.