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Only right ventricular function parameters can predict acute cellular rejection in heart transplant patients?
Session:
Comunicações Orais (Sessão 12) - Insuficiência Cardíaca 2 - Tratamento
Speaker:
Francisco Barbas de Albuquerque
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Francisco Barbas de Albuquerque; Ana Raquel Carvalho Santos; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira-Da-Silva; Valdemar Gomes; Rui Soares; Lídia de Sousa; Rui Cruz Ferreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In heart transplanted (HT) patients, endomyocardial biopsy (EMB) remains the gold-standard for acute cellular rejection (ACR) detection. Non-invasive measures to detect ACR remain a clinical challenge. Whether non-invasive analytical and transthoracic echocardiography (TTE) parameters and invasive right heart catheterization (RHC) parameters can confidently predict ACR is still not well stablished. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aim</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To determine whether analytical, TTE, and RHC parameters can predict ACR in a HT population.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective analysis of consecutive HT patients submitted to EMB between February 2016 and November 2021, who performed at the same day blood analysis, TTE and RHC. Significant ACR was defined as ≥ 2R on EMB, according to the International Society of Heart and Lung Transplantation 2004 grading. Analytical, TTE and RHC parameters were assessed by the area under curve (AUC) of Receiver Operating Characteristic curve (SPSS®) for the prediction of ACR. Statistical differences with a <em>p</em>-value <0.05 were considered significant.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 127 EMB were performed during the study period with the following histological results (0: 33%; 1R: 59%; 2R: 8%)<strong>.</strong> Mean age was 50 years, 79% were male, mean left ventricular ejection fraction was 58 ± 10% and mean BNP 808 ± 984 pg/mL. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">AUC results of analytical, TTE and RHC parameters for the prediction of ACR are depicted in Table 1. Neither analytical nor TTE parameters were able to predict ACR. Central venous pressure (CVP) (<em>p</em>=0.002) and pulmonary artery pulsatility index (PAPi) (<em>p</em>=0.009) were significantly associated with ACR. CVP > 8 mmHg had a sensitivity (S) of 60% and a specificity (Sp) of 80% for ACR ≥ 2R. ACR did not occur for CVP values < 6 mmHg (S 100% and Sp 57%). PAPi < 2 had a S of 60% and a Sp of 85% for predicting ACR. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion</span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Detecting ACR in HT patients without invasive measures remains a clinical challenge. However, two important messages can be taken from this study to our clinical practice. First, this study demonstrates that right heart function parameters, such as CVP and PAPi, are the most reliable predictors of ACR, whereas left ventricular function parameters should only be influenced later in the rejection process. Secondly, low CVP levels can rule out ACR. Because venous jugular pressure can be used to estimate CVP during a physical examination, clinicians may still have a non-invasive way to rule out ACR in HT patients.</span></span></p>
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