SPC365

Profiling RVOT systolic flow morphology in precapillary pulmonary hypertension

Session: Comunicações Orais - Sessão 27 - Ecocardiografia
Speaker: Ana Lobato de Faria Abrantes

Congress: CPC 2023
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Abrantes; Beatriz Valente Silva; Pedro Alves da Silva; Joana Brito; Ana Beatriz Garcia; Catarina Simões de Oliveira; Ana Margarida Martins; Catarina Gregório; Miguel Azaredo Raposo; João Santos Fonseca; Marta Vilela; Daniel Inácio Cazeiro; Joana Rigueira; Rui Plácido; Fausto J. Pinto; Ana G. Almeida

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In patients (pts) with pulmonary hypertension (PH), right ventricular outflow tract (RVOT) systolic Doppler flow envelope is frequently abnormal, showing a mid-systolic notch that suggests elevation of pulmonary vascular resistance (PVR). Recent studies have demonstrated that other parameters, such as time-to-notch, may be indicators of elevated pulmonary artery pressures (PAP) and disease severity, conveying an important prognostic value.&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> To evaluate the correlation between RVOT systolic flow morphology and hemodynamic parameters in pts with PH.&nbsp;&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Retrospective, single-center study of consecutive pts diagnosed with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). We included pts who performed right heart catheterization (RHC) and transthoracic echocardiogram (TTE) within a six month period. RVOT systolic Doppler flow envelope was analyzed by measuring the ejection time (ET), time-to-notch (TN), </span></span></span><span style="font-size:10pt"><span style="font-family:ArialRegular"><span style="color:#000000">pulmonary acceleration time (PAT),</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> deceleration slope, pre- and post-notching velocity peak. Clinical, epidemiological, TTE and RHC data were recorded. For statistical analysis, Student&#39;s T tests, Chi-square and non-parametric tests were performed when appropriate.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We included 79 pts, 42 with PAH (53%) and 37 with CTEPH (47%). 52 pts were women (66%) with a mean age of 58.06 &plusmn; 15.3 years. The mean follow-up (FUP) was 3.6&plusmn;2.8 years. Most pts (92.3%) were symptomatic with a WHO functional status of II or III, despite specific PH treatment (69.4% PDE5 inhibitors, 63% endothelin receptor antagonists). In our analysis a higher TN correlated negatively with hemodynamic parameters such as mPAP (p = 0.02), PVR (p=0.015), and mean right atrial pressure (mRAP), (p=0.02). Similarly, pts with higher ET showed lower mPAP and sPAP in right ventricular catheterization (p = 0.044, p= 0.05 respectively). As previously reported, lower PAT showed a positive association with sPAP (p=0.008), pulse pressure in pulmonary artery (p=0.028), mRAP (p=0.022), cardiac index (p=0.01) and pulmonary vascular resistance (p=0.04). When attempting to stratify TN and ET we noted a positive correlation with higher COMPERA score during FUP and lower clinical events, despite lack of clear statistical significance (p=0.1). Regarding the remaining RVOT flow variables no statistically significant correlations were found.&nbsp;&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">This study shows that TN and ET accurately correlate with PAP and PVR, mirroring disease severity. Therefore, RVOT systolic flow profile is a non-invasive parameter that can be used as a valid tool when evaluating patients with PH.&nbsp; </span></span></span></p>