SPC365

Echocardiographic insights redefining risk in pulmonary arterial hypertension: A Focus on Right Atrial Volume Index for Enhanced Stratification

Session: Sessão de Posters 06 - Hipertensão Pulmonar
Speaker: Liliana Sofia Gonçalves Brochado

Congress: CPC 2024
Topic: I. Hypertension
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.3 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Diagnostic Methods
Session Type: Cartazes
FP Number: ---
Authors: Liliana Brochado; João Luz; Paula Fazendas; Filipa Ferreira; Sofia Alegria; João Grade; Mariana Martinho; Barbara Ferreira; Diogo Cunha; Oliveira Baltazar; Nazar Ilchyshyn; Hélder Pereira

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<span style="font-size:10pt"><span style="font-family:&quot;Courier New&quot;"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction: </span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Pulmonary arterial hypertension (PAH) is a rare condition, defined in the 2022 ESC guidelines as a mean pulmonary artery pressure exceeding 20 mmHg, as measured by right heart catheterization. In PAH, the right atrium (RA) plays a critical role, and its size, determined by echocardiography, is crucial for risk stratification. Despite this, current guidelines still prioritize right atrial area (RAA) over the right atrial volume index (RAVI). This approach is contrary to the recommendations of international echocardiography societies since 2016, which advocate for the use of RAVI for a more accurate assessment. </span></span></span></pre>

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<span style="font-size:10pt"><span style="font-family:&quot;Courier New&quot;"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Purpose:</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"> Identify the RAVI value corresponding to the RAA, in PAH risk stratification used in the 2022 ESC guidelines. </span></span></span></pre>

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<span style="font-size:10pt"><span style="font-family:&quot;Courier New&quot;"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods: </span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">We conducted a retrospective analysis of all consecutive patients of a single-center Pulmonary Hypertension Unit, since 2002. Patients&rsquo; echocardiograms were revised for simultaneous assessment of RAA and RAVI. Over an average follow-up of 6.7 (5.9) years, we recorded a cohort of 82 patients diagnosed with PAH. From this group, we excluded 27 patients with congenital etiologies, 14 due to the insufficient quality of echocardiographic data, and one patient identified as an extreme statistical outlier. </span></span></span></pre>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Results:</span></strong><span style="font-size:10.0pt"> A total of 40 patients were included with a mean age at diagnosis of 48.8 (SD 17.8)&nbsp;years, predominantly female (78%). The most prevalent etiologies were idiopathic (33%) and connective tissue disease-associated PAH (28%). Clinical presentations included right heart failure signs in 30% of patients, rapid symptom progression in 13%, syncope history in 15%, and 78% in WHO functional class III-IV. Average 6-minute walk distance and NT-proBNP levels were 392 m&nbsp;and 1636,18ng/L (SD 2576,14), respectively. Average hemodynamics parameters were right atrial pressure 7,4 mmHg (SD 4,9); cardiac index 2,3 L/min/m2 (SD 2,1); stroke volume index 3,4 mL/m2 (SD 3,9) and mixed venous oxygen saturation 66% (SD 11). Average echocardiographic parameters were RAA 20,1 cm2 (SD 4,8); TAPSE/sPAP 0,34mm/mmHg (SD 0,18) and RAVI 37,78 mL/m2 (SD 13,67).&nbsp;Statistical analysis revealed a strong and significant correlation between RAA and RAVI (r=0.82, 95%CI: 0.69-0.90, p&lt;0.001). The derived linear relationship is expressed as &ldquo;y=2.8*X -18&rdquo;. Therefore, an RAA value of 18cm&sup2; translates to a RAVI of 32mL/m&sup2;, while an RAA of 26cm&sup2; corresponds to a RAVI of 55mL/m&sup2;.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Conclusion: </span></strong><span style="font-size:10.0pt">Our study supports a revision in HAP risk assessment guidelines, suggesting a shift to a more comprehensive approach using RAVI&nbsp;measurements. We propose categorizing risk as low for RAVI &lt; 32mL/m&sup2;, intermediate for RAVI between 32-55 mL/m&sup2;, and high for RAVI &gt; 55mL/m&sup2;. This recommendation aligns with the standards of international societies and is grounded in best clinical practices, considering that indexing measurements of the RA&nbsp;to body size pottentially offer greater accuracy tan absolute values.&nbsp;</span></span></span></p>