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Haemodynamic assessment of right ventricular overload in pulmonary hypertension: Is it time for new predictors?
Session:
Painel 10 - Doença Valvular 8
Speaker:
Ana Rita 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:
Posters
FP Number:
---
Authors:
Ana Rita F. Pereira; João Grade Santos; Maria José Loureiro; Filipa Ferreira; Ana Almeida; Rita Calé; Débora Repolho; Helder Pereira
Abstract
<p><strong>Introduction: </strong>Right ventricular (RV) adaptation to the increased pulmonary load is a key determinant of outcomes in pulmonary hypertension (PH). Pulmonary vascular resistance (PVR) is widely recognized as haemodynamic measure of RV overload. Pulmonary artery pulsitility index (PAPi) is a novel index shown to predict RV failure in acute inferior myocardial infarction and after left ventricular assist device implantation, but its prognostic value is less known in PH.</p> <p><strong>Aims:</strong> To assess predictive value of PAPi in PH and to compare it with standard haemodynamic parameters.</p> <p><strong>Methods:</strong> Retrospective study including consecutive right heart catheterizations (RHC) performed from April/2009 to October/2019 in a PH referral centre. Procedures presenting PH were selected [mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg, according european guidelines]. PAPi was calculated as [(systolic pulmonary arterial pressure – diastolic pulmonary arterial pressure)/mean right atrial pressure (RAP)], value < 1.85 had been associated with RV failure. Multivariate logistic regression was used to identify predictors of all-cause mortality. Receiver operating characteristic (ROC) curves and area under curve (AUC) were used to assess discrimination power.</p> <p><strong>Results:</strong> From a total of 569 procedures, 372 fulfilled PH criteria: mean age 57.7 ± 16.1 years, 68.3% female, 34.1% performed under pulmonary vasodilator therapy. Pre-capillary PH was diagnosed in 66.9% of cases. Chronic thromboembolic PH was the most common subtype (34.7%). Concerning haemodynamic parameters: mPAP was 41.8 ± 12.0 mmHg, mean RAP 8.1 ± 5.2 mmHg, mean RVP 8.3 ± 5.0 uWood, CI 2.5±0.8 L/min/m2 and median PAPi 6 (IQR 5.5). Mean value of mixed venous oxygen saturation was 66.8 ± 8.9 %. All-cause mortality rate was 24.2% (mean time to death 1.9 years). Pts experiencing adverse events had lower cardiac index (2.3 ± 0.6 versus 2.5 ± 0.8 L/min/m<sup>2</sup>, p < 0.01), higher values of PVR (10.1 ± 5.4 versus 7.6 ± 4.6 uWood, p < 0.01) and mean RAP (10.8 ± 6.1 versus 7.8 ± 4.6, p < 0.01). Multivariate logistic regression identified 2 independent predictors of adverse events: mean RAP (OR 1.10, 95%CI 1.03-1.18, p < 0.01) and PVR (OR 1.09, 95%CI 1.02-1.16, p = 0.04). According ROC curves, PAPi did not have discrimination power (AUC 0.4, p < 0.59) to adverse events occurrence.</p> <p><strong>Conclusions: </strong>In this study, PAPi was not an independent predictor of adverse events in PH as opposite to standard haemodynamic parameters as PVR. Further studies are needed to clarify PAPi predictive value, as it has major implications for understanding of the arterial load in diseases of the pulmonary circulation.</p>
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