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Background The pulmonary artery pulsatility index (PAPi) is a composite measure of right heart function, and low PAPi is associated with increased likelihood of mortality in patients hospitalized with cardiogenic shock. Our aim was to determine how PAPi correlates with other measures of right heart function and whether PAPi is associated with outcomes in ambulatory outpatients with advanced heart failure. Methods We assessed 673 consecutive ambulatory outpatients for heart transplantation over 10 years. The median age was 52 years, 72% were male, and dilated cardiomyopathy was the most common cause. All patients underwent detailed assessment, including right heart catheterization, and PAPi was calculated. The coprimary endpoints were death, urgent heart transplantation and mechanical circulatory support. Results Median PAPi was 2.2 (interquartile range 1.42–3.62), and variation was predominantly due to variation in right atrial pressure. PAPi was well correlated with the right atrial pressure to pulmonary capillary wedge pressure ratio (rho –0.766) but less well correlated with the right ventricular stroke work index (rho 0.561) and tricuspid annular plane systolic excursion (rho 0.292). Patients in the lowest PAPi quartile (0.16–1.41) had lower event-free survival at 1 year (68.7%) and 3 years (45.6%) compared with all other PAPi quartiles (log rank P = 0.0286). Conclusions PAPi offers a composite measure of right heart function that differs from other right heart catheter or echocardiographic measures. A PAPi of less than 1.41 is associated with adverse clinical outcomes in ambulatory outpatients with advanced heart failure.

PR interval (measured from the initial P wave to the beginning of the QRS complex) reflects the time needed for an electrical impulse to be transmitted from the sinus node to the ventricles, so it is an integration of informations about different sites of the conduction system of the heart. To find a PR interval out of normal limits is not always a benign condition as previously believed. PR prolongation may not only underlie a major conduction disturbance (as in case 2), but it has also been related to the risk of atrial fibrillation (as in case 1); furthermore it may reflect different electrophysiological abnormalities, including atrial enlargement. A short PR interval instead has been shown to be an AF predictor and is linked to higher incidence of ischemic heart disease (as in case 3).

The ECG is a useful tool that can help in the diagnosis of some congenital cardiopathies, even though it is secondary to echocardiography for the correct pathology definition. On the other hand, ECG is of primary importance for the diagnosis of arrhythmic disorders in paediatric patients as well as in the adult ones.

A correct diagnosis of a wide QRS tachycardia on standard 12-lead ECG can be challenging. The correct analysis of the ECG tracing is an extremely useful tool to distinguish a supraventricular from a ventricular tachycardia. The right diagnosis has important clinical implications. We analyzed the traditional criteria, the Brugada’s and the Verekei’s algorithms together with the early-phase analysis of ventricular depolarization (the intrinsicoid deflection or R wave peak time) as important diagnostic steps. Four clinical cases of wide QRS, tachycardias are here described together with the process description that leads to the final diagnosis.