SPC365

Analyzing the RVOT envelope in pulmonary hypertension – Simplicity is key

Session: Sessão de Posters 05 - Ecocardiografia
Speaker: Diogo Rosa Ferreira

Congress: CPC 2024
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Cartazes
FP Number: ---
Authors: Diogo Ferreira; Miguel Raposo; Ana Abrantes; Sara Prata; Tatiana Guimarães; Ana Abreu; Catarina Sousa; Fausto J. Pinto; Rui Plácido
<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></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Transthoracic echocardiography (TTE) has had an increasingly important role in non-invasive evaluation of pulmonary hypertension (PH) patients (pts). Right ventricular outflow tract (RVOT) systolic Doppler flow envelope analysis has gathered evidence of correlation with hemodynamic parameters and prognosis. Acceleration time (PAccT), the presence of mid-systolic notch, pre</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">&nbsp;and post-notch velocities and other parameters have been studied. However, this analysis may be time consuming and have significant inter-observer variability.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></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">To evaluate the correlation between RVOT systolic Doppler flow and hemodynamic parameters in pts with PH.</span></span></span></p>

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<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></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Retrospective, single-center study of consecutive pts with a strong PH suspicion, who were submitted to right heart catheterization (RHC) and TTE in the same day. RVOT systolic Doppler flow envelope was analyzed, with measurements of ejection time (ET), presence of mid-systolic notch, time-to-notch (TN), PAccT, deceleration slope, pre- and post-notching peak velocities. Clinical, epidemiological, TTE and RHC data were recorded.</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">For statistical analysis, Pearson&rsquo;s and Spearman&rsquo;s correlations, and Chi-square and Fisher&rsquo;s exact test were applied. We proceeded to ROC curve analysis to define cut-offs to severe PH (defined as mPAP&gt;45mmHg) based on PAcct.&nbsp;&nbsp;</span></span></span></p>

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<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></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We included 73 pts, with a predominance of female sex (64,4%) and mean age of 63,5 years of age. 93,2% (68) had PH confirmed by RCH, 39,7% (29) of which had clinical group 1; 8% (6) group 2; 11% (8) group 3 and 34% (25) group 4. From RHC, mean sPAP was 68,9 mmHg, mean mPAP 39,5 mmHg and mean PCWP 10,6 mmHg. Well-defined notched envelopes were identified in 38,4% of pts.&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">The presence of a notched pattern and reduced PaccT (defined as &lt;105 ms) were associated with higher sPAP, mPAP and PVR, as were with reduced RV function parameters (FAC and TAPSE/sPAP, but not TAPSE or tricuspid S&rsquo;)&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">Pre and post notch peak velocities and deceleration slope showed weak correlations with hemodynamic parameters and RV function on echo.&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">ROC curve analysis enabled the definition of a cut-off value of &lt;80 ms PAcct to determine severe PH, with an area of 0.758.&nbsp;&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions</strong></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">RVOT doppler flow analysis proved to be a valuable non-invasive tool in PH assessment. The presence of a mid-systolic notch and reduced PAccT time had good correlation with hemodynamic assessment and reduced RV function. Other time consuming measures such as time to notch, deceleration slope, pre- and post-notching peak velocities showed weak correlation, and add no significant value to assessment.</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">A cut-off value for PAcct of &lt;80 ms was established to determine severe PH, with a sensitivity of 80% and specificity of 70%.</span></span></span></p>

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