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Clinical significance of right ventricular pulmonary arterial uncoupling in hypertrophic cardiomyopathy
Session:
Comunicações Orais - Sessão 10 - Imagem em Cardiologia
Speaker:
Ana Teresa Timóteo
Congress:
CPC 2024
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Teresa Timóteo; Silvia Aguiar Rosa; Luisa Moura Branco; Ana Galrinho; Pedro Rio; Rui Cruz Ferreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Right ventricular (RV) – pulmonary arterial (PA) coupling represents the relationship between RV function and afterload in the pulmonary vascular system. It is a non-invasive surrogate on how the RV is adapted to an increased afterload in the pulmonary circulation. With exhaustion of compensatory RV remodeling, the ratio decreases and there is RV-PA uncoupling. It is a useful parameter in patients with heart failure, including in preserved ejection fraction. There is no evidence regarding the association between RV-PA coupling and hypertrophic cardiomyopathy (HCM). We aimed to evaluate this parameter in patients with HCM.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: This prospective cohort study enrolled patients with HCM without obstructive epicardial coronary artery disease, that underwent a comprehensive evaluation. Echocardiography was used to assess RV-PA coupling as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). In addition, coronary flow reserve in the left anterior descending artery (CFR_LAD) was also evaluated: diastolic coronary flow velocity was measured in basal conditions and in hyperemia and CFR was calculated as the ratio of hyperemic and basal peak diastolic flow velocities. This was used as a surrogate marker of coronary microvascular dysfunction. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET). Cardiac magnetic resonance (CMR) was also performed to evaluate RV function (volumes and ejection fraction), and the extent of late gadolinium enhancement (LGE) in the left ventricle (LV).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: We enrolled 62 patients, with a mean age of 55 (15) years, 64% males. In 64% it was an asymmetrical septal hypertrophy phenotype, in 31% an apical hypertrophy, and in 27%, it was an obstructive HCM. Mean TAPSE/PASP was 0.556 (0.23) and median was 0.50. All patients had a normal LV ejection fraction. TAPSE/PASP showed a modest predictive accuracy for peak VO2 < 20 ml/Kg/min, a marker of decreased functional capacity (AUC 0.671, 95% CI 0.535 – 0.807, p=0.022), with the best cut-off set at 0.60 (sensitivity 85% and specificity 47%). Multivariable linear regression analysis showed that the independent predictors of peakVO2 were male gender (<span style="font-family:Symbol">b</span>-estimate: 0.305, p=0.002), age (<span style="font-family:Symbol">b</span>-estimate: - 0.323, p=0.002), RV indexed end-diastolic volume (<span style="font-family:Symbol">b</span>-estimate: 0.200, p=0.043) and TAPSE/PASP (<span style="font-family:Symbol">b</span>-estimate: 0.275, p=0.005). In addition, independent predictors of TAPSE/PASP were the CFR_LAD (<span style="font-family:Symbol">b</span>-estimate: 0.378, p=0.001) and the extent of LGE in the LV (<span style="font-family:Symbol">b</span>-estimate: - 0.357, p=0.005).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: In patients with HCM, RV-PA uncoupling is associated with heart failure symptoms. Furthermore, the presence of coronary microcirculation abnormalities and the extent of LGE in the LV are independent predictors of RV-PA uncoupling. Therefore, it is associated with markers of disease severity (fibrosis and functional capacity).</span></span></p>
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