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Unmasking exercise pulmonary hypertension – does time matter?
Session:
Comunicações Orais - Sessão 12 - Hipertensão Pulmonar
Speaker:
João Mirinha Luz
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Mirinha Luz; Filipa Ferreira; Rita Calé; Sofia Alegria; Ana Cláudia Vieira; Bárbara Ferreira; Débora Repolho; Sílvia Vitorino; Ernesto Pereira; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction and objectives:</u></strong> The 2022 ESC/ERS Pulmonary Hypertension guidelines brought us the definition of exercise pulmonary hypertension (E-PH), which is characterized by a mean pulmonary artery pressure to cardiac output ratio (mPAP/CO) slope (between basal and peak exercise) above 3 mmHg/L/min, assessed by exercise right heart catheterization (E-RHC). E-RHC use incremental workloads, but different protocols have been described and the search for the best protocol will be the focus in the coming years. Our goal was to evaluate if increased mPAP/CO slope is time sensitive to the amount of exercise or seen in earlier stages of E-RHC, in patients with confirmed E-PH. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods:</u></strong> We performed a observational, cross-sectional and unicentric study that included all patients who underwent E-RHC between April 2022 and November 2023, using a protocol of 15 minutes in total, with increased work thresholds every 3 minutes apart, with workload increases of 10 Watts (W) in every threshold (50W in 15 minutes of exercise). We evaluated mPAP/CO ratio every 3 minutes, and the slope between each stage and basal RHC was assessed. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results:</u></strong> We included twenty-six (26) patients. Mean age at time of E-RHC was 64,5 years-old. Two-thirds of patients (65,4%) were females. Main diagnosis was chronic thromboembolic disease (CTED), either patients who previously were subjected to pulmonary endarterectomy and had no PH at rest or patients with CTED who had been enrolled in balloon pulmonary angioplasty programme. 70% of patients performed 9 or more minutes of exercise. Sixteen patients had confirmed E-PH, with median mPAP/CO slope in peak exercise of 5.67mmHg/L/min. In those patients, abnormal mPAP/CO slope was seen already in the first stage (at 3 minutes) and maintained at all intermediate stages until peak exercise. In patients who had E-PH excluded at peak exercise, median mPAP/CO slope was 1.20mmHg/L/min. In this latter group, mPAP/CO slope at intermediate stages showed variability along each threshold, and only on peak exercise exclusion of E-PH was definitive in these patients (table 1). At 3<sup>rd</sup> minute of exercise, patients with abnormal slope had an odds ratio of 28 (95% confidence interval 1.35-580.59, p=0.015) for having E-PH, with sensibility of 88% and specificity of 80%, and positive predictive value of 88%. </span></span></p> <p><strong><u><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></u></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> Our study shows that in patients with confirmed E-PH, significant mPAP/CO slope is evident in early stages of workload during E-RHC, and probably intense protocols are not required. Larger proportion of patients are required to confirm this hypothesis.</span></span></p>
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