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Prognostic value of relative wall thickness in heart failure with preserved ejection fraction: what is the best method for its calculation?
Session:
Posters - D. Heart Failure
Speaker:
Maria Inês Fiúza Pires
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Inês Pires; João Miguel Santos; Vanda Neto; Joana Correia; Luísa Gonçalves; José Costa Cabral; Inês Almeida
Abstract
<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Background: The HFA-PEFF diagnostic algorithm is a recently published tool to help in the diagnosis of heart failure with preserved ejection fraction (HFpEF). One of the echocardiographic diagnostic criteria is left ventricular (LV) relative wall thickness (RWT), an index of LV concentricity. LV wall thickness can be measured by echocardiography at the posterior wall (PW) and/or the interventricular septum (IVS) in parasternal long axis view. There are three methods of RWT calculation: RWT<sub>PW</sub>= 2xPW/LV dimension at end diastole (LVDd) – the most used method -, RWT<sub>IVS</sub>= 2xIVS<span style="background-color:white"><span style="color:black">/ LVDd and RWT<sub>PW+IVS</sub>= (PW+IVS)/LVDd. This study compares the prognostic value of these 3 methods of calculation in patients with acute HFpEF.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Methods: All patients admitted with acute HFpEF in a Cardiology Department during 7 years were included. RWT was considered elevated if superior to its median and was calculated with the 3 formulas. In-hospital mortality (IHM) was evaluated. The primary endpoint (EP) was a composite of all-cause mortality or hospitalization for HF during follow-up of 24 months. Statistical analysis used chi-square and Mann-Whitney U tests, binary logistic regressions, and Kaplan-Meier curves.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Results: 478 patients were studied (61.3% female, mean age 79.4±8.3years). Mean <span style="background-color:white"><span style="color:black">RWT<sub>PW</sub>, RWT<sub>IVS </sub>and RWT<sub>PW+IVS </sub>were 0.46</span></span>±0.16, 0.50±0.17 and 0.48±0.16, respectively. IHM was 3.4% and primary EP occurred in 57.8%.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">High <span style="background-color:white"><span style="color:black">RWT<sub>PW </sub>was associated with higher LV ejection fraction (LVEF) (p<0.001). </span></span>Patients with high <span style="background-color:white"><span style="color:black">RWT<sub>IVS </sub>were older (p=0.044). High RWT<sub>PW+IVS </sub>was associated with higher left atrial area (p=0.037) and higher LVEF (p=0.002).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">There was no statistically significant difference between patients with high and low RWT, calculated using the 3 formulas, in other indices that are commonly used to assess diastolic function, namely in e’ and E/e’.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">None of the 3 methods of RWT calculation was a predictor of IHM.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Survival analysis showed that patients with high <span style="background-color:white"><span style="color:black">RWT<sub>PW </sub>had higher incidence of the primary EP (</span></span></span><span style="background-color:white"><span style="font-family:"Calibri","sans-serif""><span style="color:black">43.2% vs. 16.8%, </span></span></span><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#222222">Kaplan-</span></span><span style="background-color:white">Meier </span><span style="background-color:white">χ</span><sup><span style="background-color:white">2</span></sup><span style="background-color:white">=5.99; p=0.014), but not patients with high <span style="color:black">RWT<sub>IVS </sub>(</span><span style="color:#222222">Kaplan-</span>Meier </span><span style="background-color:white">χ</span><sup><span style="background-color:white">2</span></sup><span style="background-color:white">=0.23; p=0.631) <span style="color:black">or RWT<sub>PW+IVS</sub> (</span><span style="color:#222222">Kaplan-</span>Meier </span><span style="background-color:white">χ</span><sup><span style="background-color:white">2</span></sup><span style="background-color:white">=1.92; p=0.166)<span style="color:black">.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">RWT<sub>PW</sub> was a predictor of primary EP (</span></span>OR 1.81; 95% CI 1.15-2.85; p=0.011) and this result was independent from e<sup>’ </sup><span style="background-color:white"><span style="color:black">and E/e’ (OR 2.96; 95% CI 1.08-8.10; p=0.035). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Conclusion: In this study comparing 3 formulas for calculation of RWT, <span style="background-color:white"><span style="color:black">RWT<sub>PW </sub>had better risk prediction during follow-up than RWT<sub>IVS </sub>or RWT<sub>PW+IVS</sub>. RWT<sub>PW </sub>was a predictor of all-cause mortality and </span></span>hospitalization for HF, and was independent from e<sup>’ </sup><span style="background-color:white"><span style="color:black">and E/e’, indexes that are also recommended in HFA-PEFF diagnostic algorithm. Therefore, the formula incorporating PW should be preferred in the evaluation of patients with suspected or diagnosed HFpEF.</span></span></span></span></p>
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