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Curso de Atualização em Medicina Cardiovascular 2019
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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Relation between the thickness of the right ventricular outflow tract and invasive hemodynamic parameters in patients with pulmonary hypertension
Session:
Posters 3 - Écran 3 - Circulação / Embolia Pulmonar
Speaker:
Pedro Morais
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:
Pedro Morais; Rui Plácido; Tatiana Guimarães; João Pedro Ribeiro Agostinho; Nuno Cortez Dias; Pedro Silvério António; Sara Couto Pereira; Afonso Nunes Ferreira; Inês Aguiar Ricardo; Ana Mineiro; Susana Martins; Nuno Lousada; Fausto José Pinto
Abstract
<p><strong>Introduction:</strong></p> <p>Invasive hemodynamic evaluation in pulmonary hypertension (PH) is essential for the diagnosis, determination of severity and establishment of prognosis. However, it is crucial to identify parameters that allow a non-invasive approach to optimize the evaluation and follow-up of these patients and, eventually, replace invasive catheter evaluation. The thickness of the right ventricular outflow tract (RVOT) evaluated by high resolution computed tomography pulmonary angiography (AngioCT) is a noninvasive obtainable parameter whose role in this context is not yet established.</p> <p><strong>Objective:</strong></p> <p>To evaluate the relation between the thickness of RVOT, determined by AngioCT, and the hemodynamic data obtained by right heart catheterization in patients with the diagnosis of PH.</p> <p><strong>Methods:</strong></p> <p>Retrospective single center study of consecutive patients with PAH diagnosis established by hemodynamic evaluation. All the patients were submitted to AngioCT. The following hemodynamic parameters were collected: right atrial pressure (RAP), pulmonary artery pressure (systolic - PSAP; diastolic – PDAP; mean - PMAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), cardiac index (CI), and pulmonary vascular resistance (PVR). The thickness, in millimeters, of the RVOT was measured in the sagittal plane and its correlation with the various hemodynamic parameters was accessed using Pearson correlation.</p> <p><strong>Results:</strong></p> <p>Seventy eight patients were included (69,2% female, with a median age of 67 years - IQR: 26). Based on the clinical classification (Nice 2013), 50% of the patients belong to Group 4, 28% to Group 1, 11% to Group 3 and 6% to Group 2. The majority of the patients (76%) had pre-capillary PH, 21% combined PH and 4% post-capillary PH. The mean values ??of the hemodynamic accessed parameters were: RAP 12±6mmHg; PSAP 79±23mmHg; PDAP 30±8mmHg; PMAP 48 ±14mmHg; PCWP 15±6 mmHg; CO 3.75±1.31L/min; CI 2.10±0.7 L/min/m<sup>2</sup>; PVR 10.78±6.47 Wood. The mean RVOT thickness was 5.56±1.47 mm. There was a positive and significant correlation between RVOT thickness and PSAP (R=0.36, p=0.001), PDAP (R=0.34, p=0.004), PMAP (R=0.23, p=0.004) and the PVR (R=0.36, p=0.044). A RVOT thickness > 5mm showed a good acuity for a PMAP value ≥50mmHg (AUC 0.73).</p> <p><strong>Conclusion:</strong></p> <p>The evaluation of RVOT thickness by AngioCT correlated with several hemodynamic parameters, showing promise as a potencial new tool in the diagnostic evaluation and determination of hemodynamic severity in PAH.</p>
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