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Right Ventricular Function parameters as the best acute cellular rejection predictors
Session:
Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker:
Sofia Jacinto
Congress:
CPC 2021
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.8 Cardiovascular Surgery - Transplantation
Session Type:
Posters
FP Number:
---
Authors:
Sofia Jacinto; António Valentim Gonçalves; Tiago Pereira-Da-Silva; Rui Soares; Rita Ilhão Moreira; Lídia de Sousa; Bárbara Teixeira; Rita Teixeira; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Introduction</span></span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Since the mid-1970s, the diagnosis of acute cellular rejection (ACR) has been made by endomyocardial biopsy (EMB). Whether B-Type Natriuretic Peptide (BNP), transthoracic echocardiography (TTE) parameters and right heart catheterization (RHC) parameters can detect rejection in heart transplant (HT) patients have yielded conflicting results and did not overcome the use of EMB in the first year after HT. </span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Purpose</span></span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">The aim of this study was to evaluate whether BNP, TTE and RHC parameters can be used to detect ACR in the first year after HT. </span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Methods</span></span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Prospective study of consecutive EMB performed in the first year after HT. Plasma BNP levels, TTE and RHC were performed at the same day. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Clinical significant ACR was defined as ≥ 2R, according to the ISHLT 2004 grading. The area under the curve (AUC) was analysed for statistically significant associations to detect ACR. </span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Results</span></span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">From 2017 to 2018, 50 EMB were performed with the following results: 2R - 5 (10.0%); 1R- 29 (58.0%); 0 – 16 (32%). Mean age was 48.7 ± 8.3 years, with mean BNP value of 964 ± 1115pg/ml. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">AUC results of BNP and several TTE and RHC parameters for the prediction of </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">ACR </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">are represented in the table 1. Right atrial pressure (RAP) value (p=0.027) and Pulmonary artery pulsatility index (PAPi) were the only significant predictors of ACR. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">RAP > 10mmHg had </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">a sensitivity of 60% and a specificity of 84 %, while PAPi < 2 </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">had </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">a sensitivity of 60% and a specificity of 86% for detecting ACR.</span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Conclusion</span></span></span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Detecting ACR without EMB remains a clinical challenge, but right ventricular parameters seem the best since both RAP and PAPi measured by RHC were a significant predictor of ACR in the first year after HT, while BNP and other RHC values did not correlate with ACR.</span></span></span></span></span></span></p>
Slides
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