SPC365

Three-Dimensional Echocardiography for the Assessment of Right Ventriculo-Arterial Coupling in pre-capillary pulmonary hypertension.

Session: Sessão de Posters 05 - Ecocardiografia
Speaker: Bárbara Lacerda Teixeira

Congress: CPC 2024
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Cartazes
FP Number: ---
Authors: Bárbara Lacerda Teixeira; Rita Teixeira; Ricardo Carvalheiro; Raquel Santos; João Reis; Luis Almeida Morais; Tânia Mano; Pedro Rio; Ana Teresa Timóteo; Ana Galrinho; Rui Cruz Ferreira
<p style="text-align:justify"><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:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Right ventricular maladaptation and failure determine outcome in pulmonary hypertension. The assessment of right ventricular-arterial coupling (RVAC) through the examination of pressure-volume loops is not commonly conducted. An alternative approach to assess RVAC is by integrating pressure data obtained through right heart catheterization (RHC) with right ventricular (RV) volumetric data derived three-dimensional echocardiography (3DE). </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>Objectives</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">to correlate estimations of RVAC obtained solely from doppler analysis and 3DE with those obtained using a combination of RHC and 3DE, to compare those parameters between a cohort with PH and a control without PH and to correlate RVAC with pulmonary vascular resistance.</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"><span style="color:black">A prospective registry of pre-capillary PH patients evaluated in a single tertiary center was used and compared with a control group without PH. In both groups, patients underwent same day RHC and echocardiographic assessment. </span>Effective elastance of the pulmonary artery (PA Ea), maximum end-systolic elastance of the RV (RV Emax), and right ventricular-arterial coupling (RVAC, calculated as PA Ea/RV Emax) were determined using a combination of right heart catheterization (RHC) and end-systolic volume measured by 3DE as well as through simplified formulas in 3DE that incorporated mean pulmonary artery pressure (mPAP), stroke volume, and end-systolic volume (Fig 1). <span style="color:black">Comparison of groups was assessed using t-Test or Mann-Whitney analysis. </span>Pearson&rsquo;s correlation was applied to assess correlations between continuous variables.</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>Results</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 total of 15 patients were included in the analysis: 10 pts with PH (5 group I PH and 5 group IV PH) were compared with 5 pts without PH. Significant correlations were found between PA Ea calculated by 3DE and by RHC (r = 0,569, p = 0,027), between RV Emax calculated by 3DE and by RHC+3DE (r = 0,917, p &lt;0,001) and between RVAC measured by 3DE and RHC+3DE (r = 0,788, p &lt; 0,001), although there is a consistent tendency to overestimation of 3DE elastance parameters (Fig 2).</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">Patients with pre-capillary PH present significantly higher PA Ea (p= 0,002 and p = 0,002), RV Emax (p=0,027 and p=0,014) and RVAC (p=0,014 and p = 0,020) than patients without PH, independently of the method used (Fig 3 and 4).</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">3DE PA Ea and 3DE RVAC showed significant increases with higher pulmonary vascular resistance levels (r=0,635, p = 0,011 and r = 0,548, p = 0,034). However 3DE RV Emax did not exhibit a significant increase under similar conditions(p=0,088).</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>Conclusions</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">Measurements of PA Ea, RV Emax and RVAC obtained solely from 3DE demonstrated a strong correlation with the reference measurements obtained from RHC. Patients with PH present higher PA, RV Emax RVAC measured by both methods. For higher values of pulmonary vascular resistance there was a significantly higher ventricular-arterial uncoupling.</span></span></span></p>