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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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CLEAR FILTERS
Echocardiography in pulmonary hypertension hemodynamic evaluation – A silver lining
Session:
Sessão de Posters 05 - Ecocardiografia
Speaker:
Miguel Azaredo Raposo
Congress:
CPC 2024
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Cartazes
FP Number:
---
Authors:
Miguel Azaredo Raposo; Daniel Cazeiro; Catarina Simões Oliveira; Ana Beatriz Garcia; Catarina Gregório; Ana Margarida Martins; Susana Gonçalves; Tatiana Guimarães; Ana G. Almeida; Catarina Sousa; Fausto J. Pinto; Rui Plácido
Abstract
<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 heart catheterization (RHC) is the gold standard in pulmonary hypertension (PH) diagnosis. However, its invasive nature and lack of availability justify the need for non-invasive alternatives, namely transthoracic echocardiography (TTE).</span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</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 correlation of same-day echocardiographic estimation and invasive measurements of pulmonary and right ventricle (RV) hemodynamics. </span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><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:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong> </strong>Retrospective, single-center study of consecutive pts with a diagnosis of PH, who were submitted to right heart catheterization (RHC) and TTE on the same-day. </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"> TTE derived sPAP estimation, RV-RA gradients, pulmonary artery (PA) diameter and right ventricular (RV) function, TAPSE, TAPSE/sPAP ratio, tricuspid S’ and RV fractional area change (FAC) were assessed. Values were paralleled with the hemodynamic evaluation from RHC.</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">For statistical analysis, Pearson’s and Spearman’s correlations were applied. ROC curves to define cut-offs of reduced cardiac output (CI) were obtained.</span></span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><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:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong> </strong>We included 69 pts, with a predominance of female sex (64%) and mean age of 63,7 years. As for PH clinical groups, 43% (30) were Group 1; 10% (7) Group 2; 12% (9) group 3 and 30% (23) group 4. </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">Mean sPAP-RHC was 71,2 mmHg, compared with 64,9 mmHg when estimated with echo, revealing a strong correlation (r. 0,776 p. <.001). sPAP-TTE also had a positive correlation with PVR (r. 0,653 p. <.001).</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">Assessment of RV function with FAC, TAPSE/PSAP, TAPSE and tricuspid S’ showed significant positive correlation with cardiac output and index, and significant negative correlation with PVR. RV dimensions had no significant correlation with hemodynamic measurements.</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">Through ROC curve analysis, we were able to determine cut-off points for TAPSE (<17,95 mm), Tricuspid S’ (<11,5 cm/s) and RV FAC (<33,5%) to determine reduced CI, defined as <2,5 l/min/m2. </span></span></span></p> <p style="text-align:start"> </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"><strong> </strong> sPAP-TTE assessment showed strong correlation with invasive measurements obtained in the same-day. It did, however, slightly under-estimate comparing to the RHC measured sPAP.</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"> Standard RV function parameters showed strong correlation with cardiac index, and cut-off points to determine reduced CI were established, strengthening the evidence for the value of these simple measurements in hemodynamic assessment of patients with PH. </span></span></span></p> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div id="accel-snackbar" style="left:50%; top:50px; transform:translate(-50%, 0px)"> </div>
Slides
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