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Multidimensional CT approach to predict hemodynamics in pulmonary hypertension
Session:
Comunicações Orais (Sessão 4) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 1 - Foco no TEP e Hipertensão Pulmonar
Speaker:
Joana Brito
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.3 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Sara Couto Pereira; Pedro Silvério António; Ana Beatriz Garcia; Ana Margarida Martins; Nuno Lousada; João Inácio; Tatiana Guimarães; Ana g Almeida; Fausto j Pinto; Rui Plácido
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Mean pulmonary artery pressure (mPAP) measured by right heart catheterization (RHC) is the current cornerstone on pulmonary hypertension (PH) diagnosis. Non-invasive imaging techniques as angioCT allow for an excellent visualization of heart chambers and great vessels, and its measures may be associated with hemodynamic parameters, obviating the need for some invasive procedures.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> To evaluate the association between angioCT measurements with hemodynamics, clinical and laboratory data in a precapillary PH population.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Consecutive patients (pts) with precapillary PH followed in a tertiary center were evaluated with angioCT and RHC performed within a maximum time interval of 6 months. Clinical, laboratorial, imagiological and hemodynamic data were collected from all pts at baseline and follow-up. Statistical analysis was performed with Pearson analysis and Mann-Whitney. ROC curve analysis was applied to estimate the best angioCT parameters cut-offs for severe PH (mPAP>35mmHg).</span></span></p> <p><br /> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>Our cohort included 47 pts (mean age: 64<span style="color:#010205">±16 years</span>, 60% male) 12 with clinical group I and 37 with clinical group 4. Pts had a mean mPAP of 44<span style="color:#010205">±</span>16mmHg and a mean NT-proBNP of 1109<span style="color:#010205">±1860ng/mL</span>, 56% were in functional class (FC) II and 21% in FC III. A significant correlation was observed between mean mPAP and angioCT parameters - septal angle (r 0.595, p <0.001), right ventricle axial area (r 0.463, p = 0.001), right atrium (RA) axial area (r 0.374, p 0.010), RV free wall thickness (r 0.359, p = 0.037) and RV axial diameter (r 0.416, p = 0.013). For a mPAP over 35mmHg the optimal cut-off for the previously correlated parameters were the following: septal angle value of 149º (AUC 0.788, Sn 67%, Sp 89%), RV axial area of 22.71 (AUC 0.839, Sn 73.5%, Sp 92.3%), RA axial area of 20.9mm<sup>2</sup> (AUC: 0.785, Sn 76.5%, Sp 61.1%) and RV free wall thickness of 6.45mm (AUC: 0.751, Sn 40%, Sp 100%). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">AngioCT parameters correlated not only with hemodynamics but also with clinical and laboratory parameters, as a higher RV and RA axial area had a significant positive correlation with NT-proBNP (p=0.042 and p<0.001) as well as with worse FC (p=0.043 and p=0.01). Higher septal angle and a thicker RV free wall also showed a positive correlation with worse FC – table 1.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In this pilot trial with PH pts, non-invasive dimensional parameters acquired by CT-Angio significantly correlated with hemodynamic parameters assessed by RHC – namely mPAP - functional class and NTproBNP. </span></span></p>
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