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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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A new model for accurate non-invasive prediction of transpulmonary peak-to-peak gradients
Session:
Painel 3 - Imagiologia Cardiovascular 1
Speaker:
Guilherme Lourenço
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Guilherme Lourenço; José Diogo Ferreira Martins; Petra Loureiro; Maria De Fátima Pinto
Abstract
<p>Introduction:</p> <p>The threshold for intervention in congenital heart disease with right-sided obstructive lesions depends on the haemodynamic measurements obtained during the procedure. Therefore, the accurate non-invasive estimation of the stenosis is critical to avoid unnecessary invasive procedures. However, current non-invasive estimations lack precision. We sought to create a predictive model to fine tune these indications.</p> <p> </p> <p>Methods:</p> <p>Retrospective review of all consecutive catheterizations for right-sided lesions in a single Paediatric Cardiology Department from 2016-2019. Data was gathered on demographics. Echocardiographic measurements included antegrade and tricuspid regurgitation peak instantaneous and mean estimated gradients, and end-systolic left ventricle eccentricity index (defined as the ratio between the anterior-inferior and septal-posterolateral cavity dimensions at the mid-ventricular level). Invasive measurements were peak-to-peak gradient and right to left ventricle pressure ratio. Statistical correlation and linear regression modelling were done using SPSS 20.</p> <p> </p> <p>Results:</p> <p>We included 64 patients (56% male). Mean age was 8.3 years (SD 6.7), median weight was 22 (interquartile range 39). The main obstruction was located at the valve in 31 (48.4%) patients, branch pulmonary arteries in 15, right-sided conduit in 11 and supravalvular in 5. Diagnoses were pulmonary valve stenosis or atresia with intact ventricular septum (33 pts), operated tetralogy of Fallot and variants (17 pts), transposition of the great arteries (13 pts) and truncus arteriosus (6 pts). All five echocardiographic measurements had a significant (p < 0.05) but poor to moderate correlation (r value between 0.429 and 0.615) with invasive haemodynamic measurements. In the univariate analysis, echocardiography had a low predictive value of the invasive haemodynamics. In the subgroup analysis of the valvular obstruction patients, however, we were able to create a multivariate linear regression model that predicted accurately the peak-to-peak invasive gradient, using all five echocardiographic measurements, (r<sup>2</sup> = 0.974, p = 0.014). Associations in the other subgroups were not as strong.</p> <p> </p> <p>Conclusions:</p> <p>In our sample, accurate peak-to-peak gradient prediction was possible using a regression model in the valvular obstruction subgroup. A larger prospective study is required to validate the usefulness of our model to plan invasive catheterization in patients with right-sided obstructive lesions.</p>
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