SPC365

Unveiling the interplay of Pulmonary Hypertension Parameters from Right Heart Catheterization with Cardiopulmonary Exercise Testing in Heart Failure Patients

Session: Sessão de Posters 33 - Insuficiência cardíaca - Avaliação de exercício
Speaker: Ricardo Carvalheiro

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: Ricardo Da Silva Carvalheiro; Ana Rita Teixeira; João Ferreira Reis; Pedro Garcia Brás; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira-Da-Silva; Ana Teresa Timóteo; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Background:</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> Pulmonary hypertension (PH) frequently complicates heart failure (HF), influencing prognosis and treatment decisions. This study explores the relationship between PH indicators from right heart catheterization (RHC) and Cardiopulmonary Exercise Testing (CPET) variables, providing insights into PH&rsquo;s functional implications in HF.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> In this retrospective single-center analysis, we included<span style="background-color:white"><span style="color:black"> HF with reduced ejection fraction patients (pts) who underwent both CPET and RHC. All were referred for potential indication for heart transplant or mechanical circulatory support. Correlation analyses was employed to examine the association between RHC-derived PH parameters and CPET variables. </span></span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> A total of 110 patients were enrolled (mean age of 51&plusmn;12 years, 81.8% males and 47.3% in <span style="background-color:white"><span style="color:black">NYHA class &ge; 3. </span></span>Ischemic etiology was present in 41 pts and the mean LVEF was 27.7&plusmn;7.9%. Thirty-five pts were in AF rhythm and PH was present in 70.9% of pts. Elevated mean pulmonary artery pressure (PAP) correlated with reduced peak VO<sub>2</sub> (r=-0.209, <em>p</em>=0.028), peak respiratory exchange ratio (RER) (r=-0.234, <em>p</em>=0.014) and peak O<sub>2</sub> pulse<strong> </strong>(r=-0.202, <em>p</em>=0.035). However, it was not associated with altered ventilatory efficiency represented by elevated VE/VCO2 slope (r=0.157, <em>p</em>=0.186). Still, this <span style="color:black">correlated positively with systolic and diastolic PAP (r=0.27, <em>p</em>=0.021; r=0.24, p=0.038) as well as with markers of impaired RV performance like diastolic RV pressure and TAPSE/SPAP ratio &lt;0.036 (r=0.25, <em>p</em>=0.036; r=0.48, <em>p</em>=0.002, respectively).</span> The PH cohort had a significant difference in aerobic capacity as indicated by lower pVO2 (<em>p</em>=0.028) and percent predicted pVO<sub>2</sub> (<em>p</em>=0.043), lower peak RER (<em>p</em>=0.014) and lower cardiac function during exercise as determined by <span style="color:black">peak O<sub>2</sub> pulse, </span>(<em>p</em>=0.035) compared with non-PH pts. When compared to isolated post-capillary PH, combined pre- and post-capillary PH was associated with lower O<sub>2</sub> consumption at peak or anaerobic threshold (<em>p</em>=0.038; <em>p</em>=0.030) while differences in other CPET parameters remained non-significant. &nbsp;</span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusion:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> In</span></span></span> <span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">HFrEF patients with PH, exercise capacity and cardiac function, as assessed by CPET, appear lower than in non-PH patients. Those with combined pre- and post-capillary PH revealed significantly reduced functional aerobic capacity. Initial results suggest, however, practically negligible correlations between RHC and CPET parameters in these pts.</span></span></span></span></span></p>