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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
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32. Cardiovascular Nursing
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Echocardiographic assessment of different pulmonary hypertension groups
Session:
Posters 2 - Écran 10 - Circulação / Embolia Pulmonar
Speaker:
Marta Fontes Oliveira
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.3 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Marta Fontes Oliveira; Maria Trêpa; Raquel Baggen Santos; Ricardo Costa; Inês Silveira; Sofia Cabral; Abílio Reis; Mário Silva Santos; Severo Torres
Abstract
<p>Introduction: Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). We aimed to study if different etiology groups have different echocardiographic expressions. We also assessed echocardiographic correlates of pulmonary vascular resistance (PVR) for each group.</p> <p>Methods: We collected echocardiographic and right heart catheterization (RHC) data from 77 (75% female, age 63 ± 16 years) consecutive patients with confirmed PH followed in our department from 12/2016 to 11/2018. Echocardiographic analysis was performed using Echo-Pac software from GE Healthcare®. PH group 3 and 5 were excluded due to few patients.</p> <p>Results: Group 2 PH was the most frequent etiology of PH (28), followed by group 1 (25) and group 4 (24). The echocardiographic evaluation of this population as a whole showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 17 ± 5 mm, fractional area change (FAC) 34 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -14.8 ± 5.0 and RV free wall strain was -16.2 ± 6.8. PH group 1 had a significantly lower FAC than group 2 (30 ± 2% vs 37% ± 2%, p=0.009), higher eccentricity index (EI) (1.6 ± 0.1 vs 1.1 ± 0.1, p=0.0001) and more frequently RV outflow tract (RVOT) notching (48% vs 18%, p=0.02). In group 1, EI was the only echocardiographic measure associated with PVR, even after multivariate analysis (β=10.1, p<0.001). Patients with PH group 4 had higher global RV strain and RV free wall strain than group 2 (-13.4 ± 0.8 group 4 vs -16.4 ± 0.8 group 2, p=0.015 and -13.3 ± 1.4 vs -19.0 ± 1.0, p=0.0015 respectively). In group 4, PVR was associated with FAC (β=-0.12, p=0.009), TAPSE (β=-0.44, p=0.001), global RV strain (β=0.29, p=0.039), pulmonary acceleration time (β=-0.06, p=0.03) and presence of RVOT notching (7.0 ± 0.6 wood in patients with RVOT notching vs 4.2 ± 0.8 wood, p=0.02). In multivariate analysis, only TAPSE was an independent predictor of PVR (β=-0.42, p=0.01) in group 4.</p> <p>Conclusion: Different PH groups present mild echocardiographic differences between them. EI predicts PVR in group 1 and TAPSE was the best PVR predictor in group 4. Larger studies are needed to better characterize this population.</p>
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