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Pulmonary Hipertension. When the experience overcomes the evidence

Session Poster Session 3

Speaker Adrian Lescano

Congress : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Pulmonary Hypertension
  • Session type : Poster Session
  • FP Number : P1824

Authors : A Lescano (BUENOS AIRES,AR), A Rossi (BUENOS AIRES,AR), R Caprini (BUENOS AIRES,AR), E Besmalinovich (BUENOS AIRES,AR), G Sorasio (BUENOS AIRES,AR), C Miranda (BUENOS AIRES,AR), M Vergara (BUENOS AIRES,AR), C Musante (BUENOS AIRES,AR), I Fernandez (BUENOS AIRES,AR), F Stroschein (BUENOS AIRES,AR), J Farina (BUENOS AIRES,AR), R Sckena (BUENOS AIRES,AR)

Authors:
A Lescano1 , A Rossi1 , R Caprini1 , E Besmalinovich1 , G Sorasio2 , C Miranda1 , M Vergara1 , C Musante1 , I Fernandez1 , F Stroschein2 , J Farina2 , R Sckena2 , 1QUILMES TRINIDAD CLINIC - BUENOS AIRES - Argentina , 2SANTA CLARA RED DE CLINICAS - BUENOS AIRES - Argentina ,

Citation:

Pulmonay Hypertension (PH) guidelines incorporate clinical, functional, hemodynamic and image variables as prognostic indicators. The parameters of right ventricle systolic function (RVSF), as the tricuspid annular plane systolic excursion (TAPSE), have been excluded from the international scores. 
Objectives: Determinate the value of TAPSE as a prognosic value in our patients with PH.
Methods: Patients (P) with diagnosis of PH (between 2012 and 2018), confirmed by right heart catheterization (mean pulmonary pressure = 25mmHg), were included. The data was recorded: demographic; PH group (G); clinical variables: symptoms and functional class (FC), neurohormonal: brain natriuretic peptide (BNP), hemodynamic parameters: right atrium (RA) pressure and cardiac index (CI); functional: 6 minute walk test distance (6MW), Ed data: RVSF, TAPSE and pericardial effusion (PE). Poor prognosis factors were defined according to PH international guidelines (between moderate/high risk): heart failure history, syncope, advanced FC (III/IV), 6MW <160m, BNP =300pg/dl, PE presence, RA =14mmHg and CI =2,2 l/min/m2. The outcome was follow up Mortality (M) within two years. TAPSE was analyzed as an integral variable and was dichotomized in > 16 mm (A) and = 16 mm (B). We use the STATA 14 program. T test or Chi-squared was applied, according to the variables. The logistic regression model was used to determinate the impact of TAPSE in M, integrate in a multivariate analysis.  
Results: Multicentric, analytical, prospective, included 141 P, with a 25% M, 77% female and 57 (± 18) mean age. PH G was: I 68%, II 13%, III 7 % IV 7%, V 5%. Among the prognostic factors, we highlight: advanced FC 50%, syncope 22%, 6MWT =160m 16%, RA =14 mmHg 18%, IC =2,2 26%, BNP = 300 52% and PE in 30%. Within the Ed observed: 79% RVSF deterioration (24% moderate, 18% severe), a mean TAPSE value of 18 mm (± 4,1), with 75% group A and 25% group B distribution. The relationship between M and mean TAPSE probed a significant association: 19,1 mm in the survival A group (CI 95% 18-20) vs 15,8 mm in the B group (CI 95% 14,5-17,1) and a p value: 0,003. Likewise we observe less mortality in the A group (17 vs 47%; p: 0,001). The multivariate analysis shows a correlation between mortality and different variables, such as age, HF, syncope and TAPSE value (p<0.005). When we integrate the groups, we observe that the group B presents a ß coefficient of 1,5 (0,5-2,4), with greater variation than the rest of the variables (p=0,001).The OR of the group B was 4,5, with a higher association force than the rest of the variables (age, HF, syncope), and a model adequacy of 76.6%.
Conclusions:In this population with PH diagnosis, a significant relationship between TAPSE value and Mis observed. The dichotomization of TAPSE = 16, associate in an independent way with M. These findings highlight the necessity of designing a great scale study to determinate the prognostic role of that parameter.



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