SPC365

Diastolic disfunction in precapillary pulmonary hypertension - looking left to see right

Session: Posters (Sessão 2 - Écran 5) - Doença Arterial Pulmonar e Tumores Cardíacos
Speaker: Sara Couto Pereira

Congress: CPC 2022
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: Pósters Electrónicos
FP Number: ---
Authors: Sara Couto Pereira; Pedro Silvério António; Pedro Alves da Silva; Joana Brito; Beatriz Valente Silva; Beatriz Garcia; Tatiana Guimarães; Nuno Lousada; Susana Martins; Ana g. Almeida; Fausto j. Pinto; Rui Plácido

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong>: Diastolic disfunction is an important marker of prognosis when it comes to left heart disease. However, its role on right heart disease, namely in patients with sole precapillary pulmonary hypertension (PPH) is yet to be acknowledged. </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">We aimed to recognize importance of parameters of diastolic dysfunction on prognosis in a population of patients (pts) with PPH, either with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH).</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"><strong>Methods</strong>: Single centre retrospective study, including pts with PAH and CTEPH. Clinical, laboratory and echocardiographic data were collected at beginning and at latest follow-up.</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"><strong>Results</strong>: 108 pts with precapillary hypertension were gathered - divided between PAH (49.1%) and CTEPH (50.9%) &ndash; mean age 63.1&plusmn;23years, 61% were females.&nbsp; </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">In respect to echo at baseline, mean E/e&rsquo; showed a positive association with events (p = 0.027, AUC 0.773 [0.578 -0.967], p = 0.27) in pts with PAH. Regarding the total population, both mean left atrial volume (p = 0.036) and septal e&rsquo; (p=0.031) were associated with events. In fact, a tendency to lower events on follow-up was observed with a septal E/e&rsquo; below 7. (AUC 0.733 (0.569-0.898), p = 0.014).</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">Septal e&rsquo; correlated with an increased VD-AD gradient during the follow-up (p = 0.33, r 0.553)&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">and mean E/e&rsquo; correlated with NTproBNP (p = 0.008, r = 0.426).&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">When analysing echo at latest follow-up, we saw a positive association of tissular velocities and mean E/e&rsquo; with disease severity - a worse functional class associated with higher mean E/e&rsquo; (p = 0.016) and lower septal e&rsquo; (p =0.002) and RA-RV gradient correlated with mean E/e (p= 0.039), septal e&rsquo; (p= 0.22) and lateral e&rsquo; (p= 0.032).</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">Moreover, the grade of diastolic dysfunction observed during follow-up was associated with events (7% without diastolic dysfunction, 22.7% dysfunction type 1 and 45.5% diastolic dysfunction type 2, p = 0.028) and mortality (p = 0.018).</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">Interestingly, this relationship of diastolic dysfunction with events, was seen not only because of PSAP severity on echocardiogram but also with other measures of diastolic dysfunction as noted previously.</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"><strong>Conclusion</strong>: Markers of diastolic disfunction and its grade correlate with events during follow-up, and its early quantification may guide clinical and therapeutical management. Although not statistically significant, a mean E/e&rsquo; cut-off of 7.5 seemed to better predict events at follow-up, and larger studies should try to test this hypothesis.</span></span></span></p>