SESSION TITLE: PAH and the Heart
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 08:45 AM - 10:00 AM
PURPOSE: Group II pulmonary hypertension, secondary to left heart disease, is the most common cause of the pulmonary hypertension (PH) in the western world with half of those patients having heart failure with preserved ejection fraction (HFpEF). Right heart catheterization (RHC) remains the gold standard for diagnosing pulmonary arterial hypertension (PAH) and differentiating it from left sided heart disease. A non-invasive predication method for predicting elevated pulmonary artery occlusion pressure (PAOP) in such patients is needed.
METHODS: A retrospective observational study of all adult patients referred for RHC for evaluation for PH between February 2000 and July 2010 at the University of Florida Hospital. Left atrial (LA) size on ECHO was determined by cardiologist and LA area on CT chest scan was calculated by multiplying LA vertical length by horizontal width at the largest point determined by the observer on chest CT, this was then corrected for size by dividing the area to the chest wall width. Findings were analyzed against PAOP obtained on RHC.
RESULTS: A total of 51 patients were included in the analysis that had an ECHO and CT-chest scan done within a month of the RHC. The mean age 47.7±14.3 years, 36(70.6%) were female. Average LA ECHO size (mm), LA CT area (cm2), and PAOP (mmHg) were 39.2±8.5 (range 21-63mm), 1.2±0.4 (range 0.6-2.4cm2), and 17.1±7.9 (range 3-38mmHg) respectively. The LA ECHO size and LA CT area showed significant positive correlation at α=0.05 (r=0.702, p-value=9.5x10-9). Using a regression analysis via cross-validation test, both the LA ECHO size and LA CT area correlated positively with the PAOP even after adjusting for other confounding covariates such as age, sex and BMI (LA ECHO size p-value=0.0001 and LA CT area p-value=0.004).
CONCLUSIONS: LA size on ECHO and LA area on CT correlate very significantly to each other and both are significantly associated with PAOP. Regardless of confounding factors, each measurement can be used to predict the PAOP, but this does not replace the need for RHC and PAOP measurment.
CLINICAL IMPLICATIONS: Using the LA size on ECHO or LA area on CT chest, physicians can predict PAOP before referring patients for RHC, this may help assess for HFpEF in patients being evaluated for PH and optimize their fluid status prior to performing an invasive procedure. A prospective validation study is required.
DISCLOSURE: The following authors have nothing to disclose: Ali Ataya, Abbas Shahmohammadi, Baiming Zou, Jonathan Shuster, Hassan Alnuaimat
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