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Can my echo work as a crystalball? – Echocardiographic parameters predicting residual pulmonary hypertension after pulmonary endarterectomy
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 14 - PRÉMIO JOVEM INVESTIGADOR (CLÍNICA E BÁSICA)
Speaker:
João Mirinha Luz
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Mirinha Luz; Filipa Ferreira; Sofia Alegria; Bárbara Marques Ferreira; Ana Cláudia Vieira; Débora Repolho; Diogo Cunha; Oliveira Baltazar; Nazar Ilchyshyn; Liliana Brochado; Adriana Silva; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction and aim:</strong> Chronic thromboembolic pulmonary hypertension (CTEPH) results from post thromboembolic fibrotic occlusions within the pulmonary arteries and its small branches, associated with pre-capillary pulmonary hypertension (PH). Surgical removal of those occlusions, by pulmonary endarterectomy (PEA), should be considered in all CTEPH patients (pts), being potentially curative. It is estimated that 25% of pts maintain PH after PEA, described as residual PH, which comprises therapeutic and prognostic implications. The aim of this study is to evaluate if echocardiographic (echo) parameters that could predict development of residual PH after PEA. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We conducted a retrospective, observational, unicentric study of pts with confirmed diagnosis of CTEPH subjected to PEA, between January 2010 and October 2024. All pts were subjected to throughout transthoracic echo at diagnosis. 3 to 6 months after PEA, patients were subjected to RHC to evaluate presence of residual PH (characterized by mean pulmonary artery pressure ≥30mmHg). Right heart echo parameters (disclosed in table 1) were assessed and compared between pts. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> 39 pts were diagnosed with CTEPH and underwent PEA during the follow-up period. Mean age at time of diagnosis was 57.3 years-old. 46.2% (18 pts) had documented residual PH after PEA. Echo parameters that were significantly different between the two groups were: tricuspid annular plane systolic excursion (TAPSE; p=0.009); tele-diastolic right ventricular area (TDRVA; p=0.001); tele-sistolic right ventricular area (TSRVA; p=0.003); fractional area change (FAC; 0.036); TAPSE/pulmonary artery systolic pressure (PASP) ratio (p=0.002); diastolic (DER; p=0.007) and systolic eccentric ratio (SER; p=0.036). TSRVA and TDRVA were independently associated with residual PH (p=0.023; p=0.013). By using ROC curves, pts with TDRVA above 27.13cm2 [area under the curve (AUC) 0.880, sensitivity (S) 90%, specificity (E) 90%, odds ratio (OR) 81) and TSRVA above 19.54cm2 (AUC 0.875, S 90%, E 89%, OR 72) had higher probability of developing residual PH after PEA (graphic 1 and 2).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Echo is a paramount exam when evaluating CTEPH pts, and this study shows that it can somewhat predict the development of residual PH. Ventricular remodelling in CTEPH, evaluated in terms of right ventricular area, was independently associated with residual PH, but validation in larger cohorts is mandatory. </span></span></p>
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