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Fluid challenge in right heart catheterisation – a promising approach to unveil occult HFpEF
Session:
Posters (Sessão 6 - Écran 1) - Insuficiência Cardíaca - vários
Speaker:
Carolina Pereira Mateus
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.7 Chronic Heart Failure - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Carolina Pereira Mateus; Mariana Passos; Inês Fialho; Joana Lopes; Inês Miranda; Filipa Gerardo; Marco Beringuilho; David Roque; Carlos Morais
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Heart failure with preserved ejection fraction (HFpEF) is a frequent cause of dyspnea and is expected to increase in the future alongside with obesity, hypertension and diabetes mellitus. In the clinical practice, it is sometimes difficult to confirm this diagnosis, and new diagnostic procedures are necessary. Fluid challenge during right heart catheterisation is a recent diagnostic approach to detect latent diastolic dysfunction. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We aim to assess whether fluid challenge during right heart catheterisation (RHC) is a useful tool to diagnose occult HFpEF.</span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single center retrospective study of patients with suspected HFpEF admitted for RHC. Patients with a pulmonary artery wedge pressure (PAWP) ≤15mmHg received a rapid infusion of 500 mL of intravenous fluids. Invasive haemodynamic parameters were then reassessed. Patients with an increase of PAWP to over >15mmHg were considered as having occult HFpEF.</span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 13 cases were analysed. The rapid fluid infusion had no complications. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All patients were female and the median age was 75 years, 61.5% (n=8) were obese, 46.1% (n=6) had atrial fibrillation, and 30.8% (n=4) had diabetes mellitus. All patients had a ventricular ejection fraction >50%. The median H2FpEF score was 6. Of the 13 cases of RHC, 38.5% (n=5) of patients were successful in identifying the group of pulmonary hypertension (3 had post-capillary pulmonary hypertension, 2 had pre-capillary pulmonary hypertension). The remaining 61.5% (n=8) of patients had a resting RHC non-diagnostic and had indication to do a fluid challenge, but 50% (n=4) of these exams ended before fluid challenge. In total, 53.8% (n=7) of all patients repeated the RHC after fluid challenge. In this subgroup, 71.4% (n=5) had an increase in PAWP to ≥15mmHg, therefore meeting criteria for the diagnosis of HFpEF.</span></span></p> <p> </p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Fluid challenge during right heart catheterisation is a useful tool in patients with non-diagnostic haemodynamic invasive parameters. From our perspective, this diagnostic approach is particularly useful in patients with an intermediate H2FpEF score, but further studies would be necessary to confirm our results.</span></span></p>
Slides
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