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Stroke volume index in pulmonary arterial hypertension: the new kid on the block
Session:
Posters (Sessão 3 - Écran 6) - Hipertensão pulmonar
Speaker:
João Mirinha Luz
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:
Pósters Electrónicos
FP Number:
---
Authors:
João Mirinha Luz; Filipa Ferreira; Sofia Alegria; Ana Cláudia Vieira; Débora Repolho; Rita Calé Theotónio; Sílvia Vitorino; Alexandra Briosa; João Grade Santos; Bárbara Marques Ferreira; Mariana Martinho; Diogo Santos da Cunha; Nazar Ilchyshyn; Oliveira Baltazar; Ernesto Pereira; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction and objective:</u></strong> Right heart catheterization (RHC) is the gold standard for diagnostic, therapeutic and prognostic stratification for patients with pulmonary arterial hypertension (PAH). The ESC/ERS 2022 Pulmonary Hypertension (PH) Guidelines brought a new parameter to consider in RHC – the stroke volume index (SVI), along with cardiac index (CI), right atrial pressure and mixed venous oxygen saturation (SvO2), for prognostic stratification. We aimed to see if and how SVI can be a prognostic factor in these group of patients. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods:</u></strong><strong> </strong>We performed a retrospective analysis of seventy-eight (78) baseline RHC executed in our center in PAH confirmed patients. Median SVI was compared in multiple outcomes: death, hospital admissions and need for parenteral prostanoids. Mann-Whitney U test was used for statistical purposes. We also analysed the relative risk (RR) and odds ratio (OR) for these outcomes, using the SVI cutoff of 31 mL/m2, used for prognostic assessment in ERS/ECS 2022 PH Guidelines.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results:</u></strong> Mean age at the time of RHC was 51,15 years-old [standard deviation (SD) 14,50]. 71,8% were female, and 66,7% were naïve of vasodilatators. Almost a quarter (23,7%) of patients had idiopathic PAH, and other quarter (23,7%) had PAH associated with congenital heart disease. Median SVI using thermodilution method (TD) was 32,32ml/m2, and with Fick method (Fick) was 29,14mL/m2. Our results showed significant difference for median SVI need for parenteral prostanoids using both methods (TD p=0.004, Fick p=0.015). No statistical significance was seen regarding death or hospital admissions (table 1). Regarding need for prostanoids, relative risk (RR) for SVI<31 using TD was 2,33 [95% confidence interval (CI 95%) 1,31-4,16]. Regarding death, SVI<31 by Fick was 0,49 (CI 95% 0,26-0,91), and for survival was 1,55 (CI 95% 1,04-2,30). No statistical significance was seen regarding hospital admissions.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusions:</u></strong> Lower SVI is associated with higher need for parenteral prostanoids, but surprisingly was not associated with higher incidence of death in PAH patients, being a somewhat “protective” factor in these patients. We hypothesized that the lower SVI, especially in diagnostic RHC, is a factor for premature use of prostanoids, and therefore could prolong overall survival in these group of patients. More studies are needed to confirm this hypothesis.</span></span></p>
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