SPC365

Speckle-tracking echocardiography for prediction of adverse hemodynamic parameters in heart transplant patients

Session: Comunicações Orais - Sessão 14 - Transplante cardíaco
Speaker: Francisco Barbas de Albuquerque

Congress: CPC 2023
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.8 Cardiovascular Surgery - Transplantation
Session Type: Comunicações Orais
FP Number: ---
Authors: Francisco Barbas De Albuquerque; Ana Raquel Carvalho Santos; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira da Silva; Valdemar Gomes; Lídia de Sousa; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Invasive right heart (RH) catheterization for hemodynamic assessment is widely used in heart transplant (HT) patients. Speckle-tracking echocardiography through global longitudinal strain (GLS) and myocardial work (MW) have emerged for myocardial functional assessment in many cardiac conditions. In HT patients, it is unclear whether GLS and MW can predict unfavorable hemodynamic parameters.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To assess whether GLS and MW can predict unfavorable hemodynamic parameters in HT patients.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective analysis of consecutive patients submitted to RH catheterization between February 2016 and November 2022. Transthoracic echocardiography (TTE) performed at the same day was used to calculate GLS and MW values, namely global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Area under curve (AUC) of Receiving Operator Curves (SPSS&reg;) was performed to assess GLS and MW values for adverse hemodynamic parameters prediction. Statistical differences with a <em>p-value</em> &lt; 0.05 were considered significant.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">From a total of 189 RH catheterization, 114 entered the primary analysis. Mean age was 49 years, 78% were male, mean left ventricular ejection fraction was 59 &plusmn; 10%.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mean GLS (%) value was -13 &plusmn; 3, mean GWI (mmHg%) was 1161 &plusmn; 396, mean GCW (mmHg%) was 1531 &plusmn; 449, mean GWW (mmHg%) was 160 &plusmn; 112 and mean GWE (%) was 89 &plusmn; 8.5.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">AUC results of GLS, GWI, GCW, GWW and GWE values for RH hemodynamic parameters prediction are depicted in Table 1. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">GWW was significantly increased in patients with central venous pressure (CVP) &gt; 8 mmHg (p=0.001), cardiac index (CI) &lt; 2.5 L/min/m<sup>2 </sup>, and mean pulmonary artery pressure (mPAP) &gt;&nbsp; 20 mmHg (p=0.021). Both GWW and GCW were increased when pulmonary capillary wedge pressure (PCWP) was &gt; 15 mmHg (p=0.001 and p= 0.027, respectively). GLS, GWE and GWI were not significantly associated with any adverse hemodynamic parameter.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">GWW &gt; 124 mmHg% had sensitivity (S) of 80% and specificity (Sp) of 61% to predict CI &lt; 2.5 L/min/m2, a S of 81% and a Sp of 60% for PCWP &gt;15 mmHg and a S of 75% and Sp of 55% for CVP &gt; 8 mmHg.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">GCW &gt; 1451 mmHg% had a S of 80% and Sp of 61% to predict CI &lt; 2-5 L/min/m2.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In our HT patient&rsquo;s population, GLS was slightly impaired (-13%) suggesting some subclinical myocardial dysfunction associated. Also, this study demonstrated that GWW could predict adverse hemodynamic parameters in HT patients. Hence, myocardial work might be a useful tool to routinely use in HT patients&rsquo; clinical approach.</span></span></p>