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01. History of Cardiology
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Pulmonary artery pulse pressure as a predictor of pulmonary hypertension in patients with intermediate-high risk pulmonary embolism
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 02 – HIPERTENSÃO PULMONAR: DESENVOLVIMENTOS NA ESTRATIFICAÇÃO DE RISCO, DIAGNÓSTICO E TRATAMENTO
Speaker:
Julien Lopes
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.1 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Pathophysiology and Mechanisms
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Julien Lopes; Mariana Caetano Coelho; Bárbara Lacerda Teixeira; André Grazina; João Reis; Ana Galrinho; Duarte Cacela; Rúben Ramos; Melanie Ferreira; Rui Cruz Ferreira; Luís Almeida Morais
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction - </strong>Pulmonary hypertension (PH) is a recognized long-term complication that can arise after pulmonary embolism (PE), due to persistent obstruction of pulmonary arteries by organized thrombi and secondary remodelling. Higher systolic pulmonary artery pressure (sPAP) at presentation during the acute PE event as already been stablished as a predictor of pulmonary hypertension at long-term. Also, diastolic pressure has been discussed as a marker for chronic setting. This study aimed to evaluate the predictive power of pulmonary artery pulse pressure (PAPP) for the development of PH and compare it to sPAP.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods </strong>– Patients with intermediate-high risk PE submitted to catheter-directed therapy in a tertiary centre were scheduled for follow-up to screen for PH after 3–6 month of anticoagulation with RHC. PPAP values from RHC during the acute PE episode were collected and analysed to assess their potential as predictive markers for the development of pre-capillary PH (mPAP >20 mmHg, PVR > 2 WU and PCWP < 15 mmHg in RHC). A logistic regression was used to assess the predictive value of PAPP for PH development and then a ROC curve analysis to determine the optimal cut-off threshold for PAPP as a predictor.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results </strong>– 48 patients (median age 63 years [IQR 24]; 56% female) were included. At baseline, the mean sPAP was 52,7± 14,8 mmHg and the mean dPAP was 19,33 ± 6,3mmHg. The mean PPAP was 33,4 ± 11,58 mmHg. 23 patients (47,9 %) were diagnosed with pulmonary hypertension at 3-6 month follow-up. The logistic regression model showed that PPAP was a significant predictor of PH (p=0,017) and the ROC curve analysis demonstrated a superior discriminative power compared to sPAP (p=0,004; AUC= 0,716 vs p=0,013; AUC = 0,690) with an optimal cut-off of 33,5mmHg (Sensibility 65,2%; Specificity 80%). When employing this threshold, individuals exhibiting elevated PPAP levels (> 33.5 mmHg) demonstrated a 7.5-fold increased likelihood of developing PH (OR = 7.5; p = 0.002). They were also more likely to have saddle/central PE at admission (p=0,03) and seemed to have higher values of mMiller index (p=0,09; CI 95% 0,98 – 1,35).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion – </strong>In our study, PPAP at admission demonstrated a higher discriminative power in predicting the development of PH at 3-6 month follow-up when compared to sPAP suggesting that it may serve as a more reliable predictor for identifying patients at risk of PH. This finding is of utmost importance in an era of advanced percutaneous technologies for PE treatment. </span></span></p>
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