ICU / Critical Cardiovascular Care Scores

Pulmonary Artery Pulsatility Index (PAPi) Calculator

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Calculate the pulmonary artery pulsatility index (PAPi) from invasive pulmonary artery and right atrial pressure measurements. Select a clinical context to view a population-specific reference threshold.

Hemodynamic Parameters

Enter pressure values obtained during the same hemodynamic assessment.

Peak systolic pulmonary artery pressure.

mmHg

End-diastolic pulmonary artery pressure.

mmHg

Use mean RAP; central venous pressure (CVP) may be used as a surrogate when appropriate. RAP must be greater than zero for this ratio.

mmHg

The PAPi value is the same across contexts; the associated threshold and evidence base differ.

About PAPi

The pulmonary artery pulsatility index (PAPi) is an invasive hemodynamic index calculated as pulmonary artery pulse pressure divided by right atrial pressure. It combines pulmonary artery pulsatility with right-sided filling pressure and is used as an adjunctive marker when assessing right ventricular function and right-sided hemodynamics.

Calculation

PAPi = (PASP − PADP) / RAP

  • PASP: pulmonary artery systolic pressure (mmHg).
  • PADP: pulmonary artery diastolic pressure (mmHg).
  • RAP: mean right atrial pressure (mmHg).

Because numerator and denominator are expressed in the same pressure unit, PAPi is a dimensionless ratio.

Population-Specific Thresholds

Clinical populationThreshold reportedEvidence context
Acute inferior MI with suspected RV dysfunction≤0.9ROC-derived cutoff in the original small derivation study
Cardiogenic shock / RV shock<1.0Hemodynamic criterion listed in AHA/ACC/HFSA guidance
After LVAD implantation risk assessment<1.85Reported in LVAD cohorts and AHA scientific statement

These thresholds are not interchangeable and should not be applied to an unrelated population without supporting evidence.

Measurement Considerations

  • Use invasive pulmonary artery and right atrial pressure measurements obtained under comparable hemodynamic conditions.
  • Ensure all pressure values are expressed in mmHg and refer to the same assessment period.
  • Interpret PAPi alongside the clinical examination, echocardiography, cardiac output/index, filling pressures, and the underlying disease state.
  • Changes in loading conditions, vasoactive or inotropic support, mechanical ventilation, and mechanical circulatory support may affect hemodynamic interpretation.

References

Korabathina R, Heffernan KS, Paruchuri V, et al. The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv. 2012;80(4):593–600. DOI: 10.1002/ccd.23309.
Morine KJ, Kiernan MS, Pham DT, et al. Pulmonary Artery Pulsatility Index Is Associated With Right Ventricular Failure After Left Ventricular Assist Device Surgery. J Card Fail. 2016;22(2):110–116. DOI: 10.1016/j.cardfail.2015.10.019.
Konstam MA, Kiernan MS, Bernstein D, et al. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2018;137:e578–e622. DOI: 10.1161/CIR.0000000000000560.
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145:e895–e1032. DOI: 10.1161/CIR.0000000000001063.
Dalal N, Bhardwaj A, Mohsen A, et al. Preoperative pulmonary artery pulsatility index and early right ventricular failure after left ventricular assist device implantation: A systematic review and meta-analysis. JHLT Open. 2026;14:100654. DOI: 10.1016/j.jhlto.2026.100654.
Clinical disclaimer: PAPi is an adjunctive invasive hemodynamic marker and is not a standalone diagnostic test or treatment directive. Published thresholds are population- and context-specific, and their performance may vary with measurement conditions and patient characteristics. Clinical decisions should integrate the full hemodynamic profile, imaging, clinical status, and specialist judgement.
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