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New 2022 ESC/ERS definition of pulmonary hypertension. Can we rely on the same non-invasive echocardiographic parameters?
Session:
Posters (Sessão 3 - Écran 6) - Hipertensão pulmonar
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:
Pósters Electrónicos
FP Number:
---
Authors:
Bárbara Lacerda Teixeira; Francisco Barbas de Albuquerque; André Grazina; Luis Almeida Morais; João Reis; Ana Galrinho; Miguel Antunes; Ricardo Carvalheiro; Inês Ferreira Neves; Duarte Cacela; Ruben Ramos; António Fiarresga; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong><span style="color:black">The hemodynamic definition of pulmonary hypertension (PH) has been updated, with lowering of the mean pulmonary arterial pressure (mPAP) threshold from 25 to 20 mmHg according to the new 2022 ESC/ERS Guidelines. Although there is no single echocardiographic parameter that reliably informs about PH status, some of the echocardiographic parameters cut-offs remained the same, including a peak tricuspid regurgitation velocity (PTRV) > 2.8m/s.</span> <span style="color:black">The potential underdiagnosis of PH has not been evaluated.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objectives: </strong>To evaluate the screening power of the standard echocardiographic parameters to detect PH according to the new guidelines and to establish new predictors.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong><span style="color:black">A prospective registry of</span> <span style="color:black">consecutive intermediate-high- and high-risk PE pts submitted to CDT in a single tertiary center was used. 3 months after the procedure, the patients were submitted to a right heart catheterization and echocardiogram to screen chronic thromboembolic pulmonary hypertension (CTEPH). According to new PH criteria, patients were divided in two groups, and echocardiographic parameters were analyzed regarding its predictive power. A ROC curve analysis was performed to evaluate optimal cut-offs of PTRV in predicting PH according the new guidelines.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong><span style="color:black">17 pts (60% women, mean age 59 ± 16 years) were included. Among these, 7 pts (41,2%) were diagnosed with pre-capillary PH (mPAP > 20 mmHg, PVR > 2 WU, PAWP < 15 mmHg) by RHC at 3 months of follow-up. Among echocardiographic parameters, PTRV (p 0.015), presence of tricuspid regurgitation (0.034) and right ventricle-pulmonary artery (RV-PA) coupling (p 0.041) </span>were significantly different between groups (Fig 1 A)<span style="color:black">. Other parameters, such as right ventricle dilation (p 0.849), TAPSE (p 0.100), annular tricuspid s’ velocity (p 0.646), right ventricle outflow tract acceleration time (p 0.229) and the presence of pericardial effusion (p 0.849) did not show significant differences. Regarding the PTRV, a ROC curve analysis revealed an PTRV optimal cut-off of 2.6 m/s (pressure gradient 27mmHg) in our population (AUC 0.911, p 0.030, Sn 71.4%, Sp 100%). Compared to the conventional cut-off of 2.8 m/s (pressure gradient 31 mmHg) (p 0.470, Sn 28.6%, Sp 100%), the use of PTRV > 2.6 m/s allows to reduce false negatives without losing specificity (Fig 1 B, C and D).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong>With the recent update in PH criteria, the use of the conventional PTRV cut-off leads to a significant underdiagnosis in our population. Lowering the PTRV threshold seems to increase sensitivity, <span style="color:black">without losing specificity. </span>Other standard echocardiographic parameters did not seem to predict accurately the presence of PH. </span></span></span></p>
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