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Correlating cardiopulmonary exercise testing and right heart catheterization parameters in advanced Heart Failure: insights for patient evaluation
Session:
Sessão de Posters 33 - Insuficiência cardíaca - Avaliação de exercício
Speaker:
Ana Rita Teixeira
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Rita Teixeira; Bárbara Lacerda Teixeira; João Ferreira Reis; Pedro Garcia Brás; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira-Da-Silva; Ana Teresa Timóteo; Sofia Silva; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">Background:</span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black"> Patients (pts) with severe heart failure (HF) undergoing assessment for heart transplant (HT) and/or mechanical circulatory support (MCS) require right heart catheterization (RHC). Nevertheless, non-invasive methods like cardiopulmonary exercise testing (CPET) play a crucial complementary role in risk stratification for HF pts. </span></span></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:11.0pt"><span style="background-color:white"><span style="color:black">Aim:</span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black"> To assess potential correlations between CPET and RHC parameters in HF with reduced ejection fraction (HFrEF) pts.</span></span></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:11.0pt"><span style="background-color:white"><span style="color:black">Methods:</span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black"> This retrospective single-center analysis includes consecutive HFrEF pts who underwent both CPET and RHC. All were referred for assessment by the HF team with possible indication for HT or MCS. Linear correlations were determined by measuring the Pearson’s correlation coefficient.</span></span></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:11.0pt"><span style="background-color:white"><span style="color:black">Results</span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">: A total of 110 pts were enrolled, with a mean </span></span></span><span style="font-size:11.0pt"><span style="color:black">age of 51</span></span><span style="font-size:11.0pt"><span style="color:#202124">±</span></span><span style="font-size:11.0pt"><span style="color:black">12 years and 81.8% males.<span style="background-color:white"> The majority was symptomatic, with 47.3% in NYHA class ≥ 3 and high NT-proBNP values </span>(2494</span></span><span style="font-size:11.0pt"><span style="color:#202124">±2370pg/mL)</span></span><span style="font-size:11.0pt"><span style="color:black">.<span style="background-color:white"> Ischemic etiology was present in 41 pts, the mean LVEF </span>was 27.7</span></span><span style="font-size:11.0pt"><span style="color:#202124">±7.9% and<span style="background-color:white"> 34.5% exhibiting with RV dysfunction</span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">. In our cohort, 33 pts were in atrial fibrillation, 70.9% had an ICD, of which 20.9% had a CRT-D system. The characteristics of CPET and RHC parameters are present in table 1. Prognostic CPET measures of CPET indicated low </span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:#222222">aerobic capacity, ventilatory inefficiency and abnormalities in peak (p) VO2, </span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">percent predicted pVO<sub>2</sub> and VE/VCO<sub>2</sub> slope with prognostic value (table 1). RHC parameters revealed elevated mean right atrial pressure, mean pulmonary artery pressure (PAP) values and pulmonary vascular resistance. Pulmonary hypertension (PH) was present in 78 pts and a PAPi < 1.85 in 20% of pts.</span></span></span> <span style="font-size:11.0pt">Peak VO<sub>2</sub> correlated negatively with diastolic, systolic, and mean PAP (r=-0.311, p=0.001; r=-0.286, p=0.002 and r=-0.279, p=0.003 respectively), PVR (r=-0.202, p=0.036) and RAP (r=-0.297, p=0.006) and positively with PAPi (r=0.211, p=0.027). VE/VCO<sub>2</sub> slope correlated positively with dPAP (r=0.198, p=0.043) and sPAP (r=0.217, p=0.026). </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:11.0pt"><span style="background-color:white"><span style="color:black">Conclusion:</span></span></span></strong> <span style="font-size:11.0pt">In our population, the correlations between prognostic CPET and RHC measures were practically negligible. Although CPET maintains a critical role in selecting pts for advanced HF interventions, its parameters do not substitute the RHC, which should be kept as part of the evaluation of HF pts evaluated for HT/MCS.</span></span></span></p>
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