SPC365

Right ventricular myocardial work: proof-of-concept for non-invasive assessment of right ventricular function in pulmonary hypertension patients.

Session: Prémio Jovem Investigador (Clínica e Básica)
Speaker: Bárbara Lacerda Teixeira

Congress: CPC 2024
Topic: P. Other
Theme: 37. Miscellanea
Subtheme: 21.3 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Diagnostic Methods
Session Type: Prémios, Registos e Sessões Especiais
FP Number: ---
Authors: Bárbara Lacerda Teixeira; Sofia Jacinto; Ricardo Carvalheiro; Raquel Santos; João Reis; Luis Almeida Morais; Tânia Mano; Pedro Rio; Ana Teresa Timoteo; Ana Galrinho; Rui Cruz Ferreira

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Right ventricular myocardial work (RVMW) assessed by transthoracic echocardiography allows to study and analyze the right ventricular (RV) function non-invasively, using RV pressure-strain loops. The association between these novel indexes of RVMW and invasive hemodynamic parameters has not yet been extensively studied, namely in precapillary pulmonary hypertension (PH) population. </span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objectives</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">to evaluate the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with group I and group IV PH and to compare with a control group without PH.</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></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A<span style="color:black"> prospective registry of pre-capillary PH patients was used and compared with a control group without PH. In both groups, patients underwent same day RHC and echocardiographic assessment. </span>Dedicated software for left ventricle myocardial work was used for the RV. RV global myocardial work index (RVGWI) was calculated as the area of the RV pressure-strain loops. From RVGWI, RV global constructive work (RVGCW), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were estimated. <span style="color:black">Comparison of groups was assessed using Chi-square, t-Test or Mann-Whitney analysis. </span>Pearson&rsquo;s correlation was then applied to assess correlations between continuous variables.<span style="color:black"> Predictive accuracy of RVMW parameters was assessed using a ROC curve analysis.</span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Results</span></strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="color:black">25 pts were included: 17 pts with PH (9 pts group I PH and 8 pts group IV PH) were compared with 8 pts without PH. RVGWI, RVGCW and RVGWW were significantly higher in PH patients than in controls (p &lt; 0,001), while RVGWE was significantly lower (p &lt; 0,001) (Fig 1). Significant correlations (Fig 2 and 3) were found between mean pulmonary artery pressure, pulmonary vascular resistance, venous oxygen saturation and RVGCW, RVGWW and RVGWE; between cardiac output (CO), RV stroke work index and RVGWI, RVGCW and RVGWW; between cardiac index (CI), RV stroke work and RVGCW and RVGWW; between stroke volume (SV), SV index, NT-proBNP and RVGWW and RVGWE; between pulmonary artery pulsatility index and RVGWI and RVGCW. None of the RVMW parameters correlated well with right atrium pressure. According with ROC curve analysis, all RVMW parameters, with the exception of RVGWE (p = 0,327), are good predictors of PH. Comparing with the prediction power of RV GLS (AUC 0,906, p = 0,001), RVGCW performed better (AUC 0,984, p &lt; 0,001), RVGWI performed equal (AUC 0,906, p = 0,001) and RVGWW was inferior (AUC 0,777, p = 0,030).&nbsp; </span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Patients with pre-capillary PH present significantly higher RVGWI, RVGCW and RVGWW and lower RVGWE than patients without PH. Echocardiographic RVMW-derived indexes show strong correlation with invasive pulmonary arterial pressure and resistance, CO and CI, venous oxygen saturation, invasive RV function indexes and NT-proBNP. RVGCW seems to be a powerful predictor of PH, comparing with RV GLS and the other RVMW parameters. </span></span></span></p>