SPC365

The relative pulmonary to systemic pressure ratio as a measure of prognostic value in patients with pulmonary arterial hypertension – the never-ending quest to improve risk stratification.

Session: Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker: João Grade Santos

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: Posters
FP Number: ---
Authors: João Grade Santos; Ana Rita Pereira; Mariana Martinho; Barbara Ferreira; Alexandra Briosa; Sofia Alegria; Filipa Ferreira; Rita Calé; Sofia Almeida; Hélder Pereira

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Introduction:</span></span></strong>&nbsp;<span style="background-color:white"><span style="color:#212121">The relative pulmonary to systemic pressure ratio, calculated by mean pulmonary arterial pressure/mean arterial pressure (mPAP/MAP), has been already studied and of proven value in the context of cardiac surgery. However, little is known on the prognostic value of this parameter in patients with pulmonary arterial hypertension.</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Purpose:</span></span></strong><span style="background-color:white"><span style="color:#222222">&nbsp;Our aim was to assess the prognostic value of the </span></span><span style="background-color:white"><span style="color:#212121">relative pulmonary to systemic pressure ratio in patients with pulmonary arterial hypertension.</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Methods</span></span></strong><span style="background-color:white"><span style="color:#222222">:&nbsp;We performed a 9 year retrospective analysis of all patients with pulmonary arterial hypertension as diagnosed by right heart catheterization in a single expert centre.&nbsp;Medical records were analysed for demographic, procedural and outcome data.</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Results</span></span></strong><span style="background-color:white"><span style="color:#222222">: Of the 321 patients assessed and submitted to RHC, 82 patients had the diagnosis of pulmonary arterial hypertension and were analysed. The mean age at time of diagnosis was 47 </span></span><span style="color:black">&plusmn; 17 with a female preponderance (74%).</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">In a median follow up of 5 &plusmn; 3,8 years; 24% of patients had an admission for cardiovascular (CV) causes, 39% progressed to the use of parenteric prostanoids, 2,4% were submitted to lung transplant and 36,6% had died;</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#222222">A higher </span></span><span style="background-color:white"><span style="color:#212121">mPAP/MAP correlated significantly with death (Mann- Whitney U; p= 0,03) and a compositive of admissions for CV causes, progression to intravenous prostenoids, lung transplant and death (Mann- Whitney U; p= 0,006). In a model of</span></span> logistic regression the sole use of <span style="background-color:white"><span style="color:#212121">mPAP/MAP parameter had a higher predictive ability for the compositive of events than a model based on the mean pulmonary artery pressure</span></span> (OR: 1285 95% CI 6,54 &ndash; 252728 p: 0,008; r<sup>2</sup> 0,23 vs OR: 1,051 95% CI 1,001 &ndash; 1,104 p: 0,046; r<sup>2</sup> 0,11). <span style="background-color:white"><span style="color:#212121">The ROC curve analysis demonstrated a greater discriminative capability of the model aswell (AUC 0,76; p= 0,002 vs AUC 0,71; p= 0,016), with the best cut-off value for mPAP/MAP defined as 0,5139 for a sensitivity of 70% and a specificity of 71%.</span></span></span></span></p>

<p><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">Conclusions</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">:&nbsp;</span></span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#212121">The evaluation of the relative pulmonary to systemic pressure ratio may serve as a useful prognostic indicator, more adequate than the assessment of the mean pulmonary arterial pressure alone.</span></span></span></span></p>