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Research Snapshot Theater: Pulmonary/Cardiovascular, Adult II

Pulmonary-Systemic Hemodynamic Ratios Predict Mortality in ICU Patients With Pulmonary Hypertension

Monday, March 23, 2026
10:15 AM - 11:15 AM Central Time
Location: Connections Central - RST 18
  • LC

    Lucia Costanza, BA

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • TS

    Thor Stead, MD

    Anesthesiology Resident
    New York-Presbyterian/Weill Cornell Medical Center

    Disclosure information not submitted.

  • MJ

    Maurice Joyce, MD, EdM, FASA

    Anesthesiologist and Intensivist
    Tufts Medical Center

    Disclosure information not submitted.

  • AM

    Andrew Maslow, MD

    Anesthesiologist
    The Warren Alpert Medical School of Brown University

    Disclosure information not submitted.

Introduction: The right ventricle (RV) and pulmonary artery (PA) are coupled under low pulmonary vascular resistance (PVR), intact RV contractility, and preserved ventricular interdependence (VI). The left ventricle (LV) contributes 20–80% of RV systolic function, while RV failure impairs LV filling (diastolic VI). The interventricular septum (IVS) mediates VI; its position and shape are influenced by the transseptal gradient, which reflects pulmonary-to-systemic pressure relationships. Pulmonary hypertension (PHTN) disrupts RV-PA coupling. While right heart catheterization (RHC) and transthoracic echocardiography (TTE) measure PA pressures and PVR for diagnosis and management, we hypothesized that mortality is better predicted by pulmonary-to-systemic hemodynamic ratios.


Methods: We retrospectively reviewed 159 adults with PHTN admitted to the cardiac ICU who underwent RHC. Inclusion required TTE within two months of RHC. Data included demographics, TTE and RHC metrics, and 12-month outcomes (readmission, renal failure, stroke, or mortality). Logistic regression identified predictors of mortality.


Results: No single pulmonary hemodynamic variable from RHC independently predicted mortality. In contrast, pulmonary-to-systemic ratios were strongly associated: PASP/SBP (B=3.6, p< 0.01), mPAP/MAP (OR 24.8, p=0.01), and PVR/SVR (OR 46.3, p< 0.01). Neither MAP nor RAP alone were predictive, but systemic perfusion pressure (SPP = MAP – RAP) less than 75 mmHg was associated with mortality (sensitivity 71%, specificity 71%; p< 0.01, R2 12.2%). TTE assessment of RV was incomplete: fewer than 56% of studies included RVSP, RAP, TAPSE, or S’. Qualitative RV assessments were not associated with mortality.


Conclusions: Although guidelines use PA pressures and PVR to stage PHTN, our study demonstrates that pulmonary-to-systemic ratios and SPP better reflect hemodynamic function and predict mortality. Qualitative TTE metrics were not predictive, possibly reflecting limited accuracy or the distinction between contractility and performance. These results highlight the role of VI and IVS mechanics in supporting RV-PA coupling and hemodynamic stability.