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Improving risk stratifcation of pulmonary hypertension patients
Session:
CO 19- Hipertensão Pulmonar
Speaker:
João Pedro Dias Ferreira Reis
Congress:
CPC 2021
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:
João Pedro Reis; Marta Nogueira; Lídia Sousa; Luísa Branco; Ana Galrinho; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Background: According to the 2016 ESC/ERS Guidelines on Pulmonary Hypertension (PH), the right atrial area (RAA) and the presence of a pericardial effusion (PE) are the two main echocardiographic prognostic markers in PH patients (pts). Our aim was to assess the predictive ability of these two parameters. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Methods: Pts with PH were prospectively studied and several clinical/demographic/echocardiographic were retrieved as well as data from six-minute walk test (6MWT) and brain natriuretic peptide (BNP). All-cause mortality was analyzed by PE, RAA and other echocardiographic parameters for positive (PPV) and negative predictive value (NPV) to detect if </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">the current guideline recommended cut-offs can precisely stratify risk in this setting.</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> A survival analysis was performed to evaluate risk stratification </span></span><span style="font-family:"Times New Roman","serif"">(RS) </span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">provided by several different cut-offs.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Results: A total of 51 PH pts (mean age 54±46 years, 33.3% male, baseline BNP of 342.4±439.9pg/mL, mean 6MWT distance of 360.3±109.2 meters and baseline pulmonary artery systolic pressure of 78±26mmHg), of which 64.7% had Group I PH (GI) and 35.3% presented chronic thromboembolic pulmonary hypertension. There were no significant differences between these two groups, however pts in GI were significantly younger (<em>p</em> = 0.001), achieved a lower 6MWT distance (<em>p</em> = 0.038) and had worse values of right ventricular strain (<em>p</em> = 0.040). 27 pts (52.9%) died during a mean follow-up of 52 months, with no differences between groups (<em>p</em> = 0.756). The presence of a PE had a low NPV and PPV for the primary endpoint (45.0% and 45.5%, respectively), aswell as the guideline recommended cut-offs for RAA (18cm<sup>2</sup>: NPV - 50.0% and PPV – 55.2%; 26cm<sup>2</sup>: NPV - 51.3% and PPV – 66.7%). A Pulsed Doppler Tei index (TI<sub>p</sub>) cut-off of 0.40 had a higher NPV (70.8%) and PPV (74.1%). By Kaplan-Meier analysis, neither the presence of PE (log rank <em>p</em> = 0.508) nor the recommended RAA cut-offs provided accurate risk discrimination (log rank <em>p</em> > 0.05 for all). Pts below a TI<sub>p</sub> cut-off of 0.40 presented a significantly lower survival during follow-up (log rank <em>p</em> = 0.002)</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Conclusion: The currently recommended echocardiographic prognostic markers cannot precisely discriminate risk in PH pts. Markers of Right Ventricular Dysfunction may improve RS in this population.</span></span></span></span></p>
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