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Right atrial mechanics in chronic thromboembolic pulmonary hypertension: the right measure?
Session:
CO 18 - Circulação Pulmonar
Speaker:
Patrícia M. Alves
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.3 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Patrícia M. Alves; Ana Vera Marinho; Rui Baptista; A. Marinho-Da-Silva; Mariano Pêgo; Graça Castro
Abstract
<p>BACKGROUND: Regardless of etiology, right ventricular (RV) dysfunction is considered the major determinant of morbidity and mortality in pulmonary hypertension (PH). We assessed RV function and right atrium (RA) mechanics through 2-dimensional speckle-tracking echocardiography (2D-STE) in different groups of PH.</p> <p>METHODS: We included all 91 PH incident cases followed in our center in the previous 5 years, group 1 (pulmonary arterial hypertension – PAH) (n=63) and group 4 (chronic thromboembolic PH – CTEPH) (n=28). RV global longitudinal strain (RVLS) and RA mechanics were assessed through 2D-STE. Global atrial strain and atrial strain rate during systole (RAsys and SRs), early diastole (RAe, SRe), and late diastole (RAa, SRa) were measured, corresponding to RA reservoir, conduit and contractile functions, respectively. These parameters were correlated to clinical, analytical and right heart catheterization (RHC) data.</p> <p>RESULTS: Mean age was 48±19 years for PAH and 59.7±16 years for CTEPH; 62% were women. Mean tricuspid annular plan systolic excursion (TAPSE) and tricuspid regurgitation velocity (TRV) did not vary between groups. RVLS values were numerically better in CTEPH (-13±4% vs -10±9%, p=0.170). RA mechanics was globally and statistically superior in CTEPH patients (table 1). In the global cohort, BNP values (r<sup>2</sup>=0.53, p=0.003) and RHC-derived cardiac index (CI) (r<sup>2</sup>=0.51, p=0.039) at admission were correlated to RA ?sys, but not to RVLS. In CTEPH patients, BNP values were only moderately correlated with RV diameter (r<sup>2</sup>=0.33, p=0.005), TAPSE (r<sup>2</sup>=0.42, p=0.003) and RA volume (r<sup>2</sup>=0.50, p<0.001), but were strongly correlated with RVLS (r<sup>2</sup>=0.57, p= 0.018), RAsys (r<sup>2</sup>=0.67, p=0.027) and RAa (r<sup>2</sup>=0.59, p=0.004). A similar pattern of correlation was seen for CI [TAPSE (r<sup>2</sup>= 0.3, p=0.02), RVLS (r<sup>2</sup>=0.56, p=0.041), RAsys (r<sup>2</sup>=0.64, p=0.036) and RAa (r<sup>2</sup>=0.58, p=0.004)]. Pulmonary vascular resistance (PVR) was only associated to RAa (r<sup>2</sup>=0.56, p=0.007) and mean pulmonary artery pressure (mPAP) to RAe (r<sup>2</sup>=0.72, p=0.012).</p> <p>CONCLUSIONS: 2D-STE derived RVLS and RA mechanics demonstrated stronger correlations with established prognostic factors in CTEPH, as BNP or RHC-derived indexes, than currently used morphological parameters, as TAPSE or cavity dimensions.</p>
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