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Evaluation of RV-arterial coupling in advanced heart failure
Session:
Posters (Sessão 4 - Écran 4) - Insuficiência Cardíaca 4 - Vários 2
Speaker:
João Pedro Dias Ferreira Reis
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Pedro Reis; Pedro Brás; Vera Ferreira; António Gonçalves; Tiago Pereira da Silva; Ana Timóteo; Ana Galrinho; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Introduction</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Echocardiographically determined TAPSE/PASP is a noninvasive measure of RV-arterial coupling. TAPSE/PASP ratio is a potent independent predictor of precapillary PH and prognosis in heart failure and pulmonary arterial hypertension, with a prognostic cutoff value of 0.36 mm/mmHg.</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"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Objective </span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">To assess the prognostic impact of TAPSE/PASP in a population of advanced HF patients.</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"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Methods</span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Prospective evaluation of adult patients with advanced HFrEF referred to our Institution for evaluation with HF team and possible indication for urgent heart transplantation (HT) or MCS. <span style="color:black">Patients</span> were followed up for 2 years for the primary endpoint of cardiac death and HT. <span style="color:black">Echocardiographically determined TAPSE/PASP ratio was used to assess RV-arterial coupling and a</span> survival analysis was performed to evaluate the prognostic impact of the suggested cutoff of <span style="color:black">0.36 mm/mmHg.</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"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Results </span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">A total of 450 <span style="color:black">HFrEF</span> patients with a </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">mean age of 56±12 years, of which 80% are male, and with a mean LVEF of 29±4%, mean TAPSE of 19±3 mm and <span style="color:black">PASP </span>of 38±11mmHg. The mean <span style="color:black">TAPSE/PASP was 0.80</span>±0.28<span style="color:black">. </span>Fifty-four patients (12%) met the primary endpoint. Patients with RV-arterial uncoupling (TAPSE/PASP < 0<span style="color:black">.36 mm/mmHg</span>) were more likely to have a non-ischaemic etiology for HF (66.7% vs 40%, p = 0.047), had a lower prevalence of diabetes (53.3% vs 77.9%, p = 0.041), a higher prevalence of moderate-to-severe mitral regurgitation (33.3% vs 13.0%, p = 0.035), a lower LVEF (26.2±6.1 vs 29.9±5.9, p = 0.038), a higher prevalence of RV dysfunction (73.3% vs 26.7%, p < 0.001) and worse cardiopulmonary fitness (pVO<sub>2</sub>: 12.7±5.1 vs 15.8±6.0 ml/kg/min, p = 0.047; VE/VCO<sub>2</sub> slope: 49.5±17.2 vs 37.6±9.7, p < 0.001; cardiorespiratory optimal point: 36.9±11.3 vs 29.0±6.4, p < 0.001). More patients in the group of <span style="color:black">TAPSE/PASP < 0.36 mm/mmHg met the primary endpoint (33.3% vs 9.6%, p = 0.034) and more patients underwent urgent HT (13.3% vs 1.4%, p = 0.44). RV-arterial coupling </span>was associated with a lower survival free of events during follow-up (log-rank p = 0.010).</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"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Conclusion</span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">RV-arterial coupling predicts a worse prognosis</span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> in advanced HF patients, with those below a cutoff of <span style="color:black">0.36 mm/mmHg</span> having lower survival. This variable may improve risk stratification in this setting.</span></span></span></span></p>
Slides
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