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Exploring RV-Arterial Coupling: Comparing CMR-Derived RV Strain and Echo-Based Myocardial Work Indices in Pre-capillary Pulmonary Hypertension
Session:
SESSÃO DE POSTERS 38 - ANÁLISE DE DEFORMAÇÃO MIOCÁRDICA
Speaker:
Ricardo Carvalheiro
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Cartazes
FP Number:
---
Authors:
Ricardo Carvalheiro; Margarida Figueiredo; Bárbara Lacerda Teixeira; Inês Neves; Miguel Antunes; Isabel Cardoso; Vera Ferreira; João Reis; Ana Galrinho; Sílvia Aguiar Rosa; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction</span></strong><span style="color:black">: Right ventricular-arterial coupling (RVAC), measured by the end-systolic to arterial elastance ratio (Ees/Ea), is the gold standard for assessing right ventricular (RV) function to increased afterload in pulmonary hypertension (PH). However, this method is time-consuming. The stroke volume (SV) to end-systolic volume (ESV) ratio offers a simplified, prognostically relevant alternative, with a cut-off value of 0.5. Cardiac magnetic resonance (CMR) can assess this ratio and derive strain metrics, while transthoracic echocardiography (TTE) enables RV myocardial work (RVMW) evaluation via pressure-strain loops. The relationship between these parameters, particularly in pre-capillary PH, remains underexplored.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Objectives</span></strong><span style="color:black">: To investigate the relationship between the SV/ESV ratio, CMR-derived RV strain, and TTE-derived RVMW in Group I and IV PH patients, and to compare these parameters in patients with SV/ESV ratios above and below 0.5.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods</span></strong><span style="color:black">: Thirteen pre-capillary PH patients underwent CMR, TTE, and right heart catheterization. CMR feature-tracking assessed RV strain, while TTE software analyzed RV myocardial work indices.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results</span></strong><span style="color:black">: Patients (69% women, mean age 67) had a mean PAP of 35 mmHg (± 13.5) and PVR of 4.8 WU (± 4.9). SV/ESV ratio strongly correlated with CMR-derived RV ejection fraction (RVEF) (r = 0.888, p < 0.001) and circumferential strain (CPS) (r = 0.538, p = 0.037), but not with longitudinal strain (LPS). TTE-derived RVMW showed significant correlations between SV/ESV ratio and global work index (RVGWI) (r = 0.580, p = 0.038) and constructive work (RVGCW) (r = 0.654, p = 0.015). In contrast, wasted (RVGWW) and efficient work (RVGWE) showed no significant associations. Patients with SV/ESV < 0.5 exhibited lower RVEF (48 ± 7.1 vs 61 ± 5.5, p = 0.004), lower CPS strain (-10.9 ± 3.0 vs -15.8 ± 2.9, p = 0.015), but higher RVGWI (828 ± 167.4 vs 526 ± 192.0, p = 0.015) and RVGCW (1061 ± 228.5 vs 698 ± 141.0, p = 0.004).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusion</span></strong><span style="color:black">: The SV/ESV ratio correlated with both CMR-derived circumferential strain and TTE-derived RV myocardial work indices (RVGWI and RVGCW). Patients with a lower SV/ESV ratio demonstrated lower strain but higher work indices, suggesting compensatory mechanisms. Larger studies are needed to validate these findings and assess their prognostic value.</span></span></span></p>
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