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CTEPH: relevance of the new 2022 ESC/ERS definition of pulmonary hypertension and impact on diagnosis accuracy by right heart catheterization
Session:
Comunicações Orais - Sessão 10 - Hipertensão Pulmonar Tromboembólica Crónica
Speaker:
Bárbara Lacerda Teixeira
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bárbara Lacerda Teixeira; André Grazina; Luis Almeida Morais; João Reis; Ana Galrinho; Francisco Albuquerque; Inês Ferreira; Miguel Antunes; Ricardo Carvalheiro; Duarte Cacela; Rúben Ramos; António Fiarresga; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Background:</span></span></span></strong> <span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">The hemodynamic definition of pulmonary hypertension (PH) has been updated, lowering of the mean pulmonary arterial pressure (mPAP) threshold from 25 to 20 mmHg. Plus, pulmonary vascular resistance > 2 Wood units and pulmonary arterial wedge pressure < 15 mmHg are essential for the definition of pre-capillary PH according to the new 2022 ESC/ERS Guidelines. However, the impact of these revised criteria on the number of patients (</span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">P</span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">) reclassified as PH has not been extensively studied, namely in chronic thrombo-embolic pulmonary hypertension (CTEPH) population.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Objectives:</span></span></span></strong><strong> </strong><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">To analyze the proportion of </span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">P</span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> reclassified as CTEPH according to the new 2022 ESC/ERS hemodynamic criteria in the subset of acute PE </span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">P</span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> treated with Catheter Directed Therapies (CDT) after 3 months of effective anticoagulation and to compare their clinical and hemodynamic profile.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Methods:</span></span></span></strong> <span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">A prospective registry of consecutive intermediate-high- and high-risk PE </span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">P</span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> submitted to CDT in a single tertiary center was used. Clinical, biomarkers, echocardiographic, CT, pulmonary angiogram and right heart catheterization (RHC) data were systematically collected at admission and 3 months after CDT. </span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">P</span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> were divided in groups according to the old and new hemodynamics criteria for PH. The predictive accuracy of RHC parameters were assessed w/ a ROC curve analysis.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Results:</span></span></span></strong><strong> </strong><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">17 </span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">P</span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> (60% women, mean age 59 ± 16 years) had baseline and 3 months follow-up assessment and were included. Among these, 4 (23.5%) were reclassified to have pre-capillary PH, meaning that, at 3 months of follow-up, RHC showed that 7 </span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">P</span></span></span><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> had PH according to the new guidelines instead of only 3 (41.2% vs 17.6%, p=0.023). Patients that developed CTEPH were more likely to be older (p=0,014), female (p=0,05), to have an acute-on-chronic PE presentation (p=0,027) and to have a longer duration of symptoms (p=0,018). No difference between groups in the type of CDT used. Regarding PH predictors in RHC, higher residual perfusion defects (assessed by modified Miller index), lower cardiac output (CO) and lower PA oxygen saturation showed diagnostic prediction for CTEPH according to the new guidelines but not according to previous ones. In ROC curve analysis, AUC for modified Miller was 0.814 with Sn of 71% and Sp 70% for a cut-off of 2, for CO was 0.871 with Sn of 71% and Sp 90% for a cut-off of 5.2 L/min and for PA oxygen saturation was 0.867 with Sn of 83% and Sp 70% for a cut-off of 69%.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Conclusion:</span></span></span></strong><strong> </strong><span style="font-size:13.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">The new 2022 ESC/ERS criteria for PH have led to a significant increase in patients classified as CTEPH after intermediate-high- and high-risk PE submitted to CDT. With the new cut-offs, among hemodynamic parameters at 3 months of PE patients submitted to CDT, residual perfusion defects, lower CO and lower PA oxygen saturation have shown to correlate with the presence of CTEPH. With the prevalence increase of CTEPH diagnosis, better care should be atteint in the acute and chronic phases of this disease.</span></span></span></span></span></span></p>
Slides
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