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Predictors of persistent pulmonary hypertension after pulmonary endarterectomy in CTEPH
Session:
Sessão de Comunicações Orais - Hipertensão Pulmonar e Congénitos
Speaker:
Sara Couto Pereira
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sara Couto Pereira; Rui Plácido; Tatiana Guimarães; Joana Rigueira; Tiago Graça Rodrigues; Inês Aguiar Ricardo; Pedro Alves Da Silva; Joana Brito; Beatriz Silva; Paula Campos; Ana G. Almeida; Ana Mineiro; Nuno Lousada; Fausto José Pinto
Abstract
<p><strong>Introduction:</strong></p> <p>Pulmonary endarterectomy (PEA) is the treatment of choice for most patients (pts) with chronic thromboembolic pulmonary hypertension (CTEPH) in the presence of favorable anatomical features and can be potentially curative.</p> <p>The <strong>aim</strong> of this study was to identify clinical and hemodynamic predictors of persistent pulmonary hypertension (pPH) after PEA.</p> <p><br /> <strong>Methods: </strong></p> <p>Retrospective single-center study of consecutive pts with clinical and hemodynamic diagnosis of CTEPH undergoing PEA. Demographic, clinical, laboratorial, CT scan and hemodynamic data were collected before and after the procedure. For statistical analysis chi-square and T-student tests were used, with prediction of clinical, laboratorial and hemodynamic response with binary logistic regression model.</p> <p><br /> <strong>Results:</strong></p> <p>Between January 2016 and February 2019, 24 pts with CTEPH underwent PEA (mean age: 59.7±12.9 years; 54.2% were female, basal weight: 80.3±17.3Kg). The mean follow-up was 5.6±6.4 months. Heritable coagulopathy was diagnosed in 20.8% pts and antiphospholipid syndrome in 12.5%. All the pts were under anticoagulation therapy and 87.5% pts were under specific pulmonary vasodilator therapy (sildenafil 41.7%; bonsentan 16.7%; macicentan 4.2%; ambrisentan 12.5%; epoprostenol 4.2%; riociguat 37,5%). </p> <p>At baseline, median WHO functional class was II, 6-minute walk distance 312.2±90.9m and 37.5% of pts were under long duration oxygen therapy. Regarding laboratorial data, mean hemoglobin (Hb) was 13.9±2.1g/dL, mean Cr 1.1±0.28 mg/dL and mean NT-proBNP 148.7±234.0 pg/mL.</p> <p>At basal hemodynamic evaluation, the mean pulmonary artery pressure (mPAP) was 51.0±11.6 mmHg, mean pulmonar capillary wedge pressure (PCWP) 13.4±3.7 mmHg, cardiac output 3.8±1.0 L/min and cardiac index (CI) 1.9±0.7L/min/m2. On CT scan, the mean pulmonary artery diameter was 37.4±6.6mm, right ventricle (RV) and left ventricle (LV) basal diameters were 53,4±8,5 mm and 40.1±7.7 mm on axial CT sections, respectively. RV/LV basal diameters ratio was 1.39±0.44 mm. RV and LV areas were 33.6±11.8 mm and 24.2±7.7 mm on 4-chamber view, respectively.</p> <p>After surgery, 45.8% pts (n=11) had pPH. There was an association of pPH with presurgical low weight and Hb levels (p=0.019 for both), higher WHO functional class (p=0.023), less LV basal diameter and LV area (p=0.045; p=0.017). On univariate analysis, functional WHO class (p=0.039, OR 11.7, CI 1.14-119.54), basal Hb values (p=0.039, OR 0.601, CI 0.371-0.97) and smaller LV area (p=0.044, OR 0.837, IC:0.704-0.995) were predictors of pPH, the last one being an independent predictor (p=0.044, OR 0.837, IC:0.704-0.995).</p> <p><strong>Conclusion:</strong><br /> This study showed that functional WHO class, basal Hb values and smaller LV area were predictors of PPH. Smaller LV area was also an independent predictor of pPH. We hypothesized that remodeling conditions secondary to RV dilatation may be related with worst outcomes after PEA.</p>
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