Tesi etd-10242024-001236
Link copiato negli appunti
Tipo di tesi
Corso Ordinario Ciclo Unico 6 Anni
Autore
BAZAN, LORENZO
URN
etd-10242024-001236
Titolo
Dynamic changes in echocardiographic estimate of pulmonary capillary wedge pressure improves outcome prediction in chronic heart failure
Struttura
Classe Scienze Sperimentali
Corso di studi
SCIENZE MEDICHE - SCIENZE MEDICHE
Commissione
Tutor Prof. PASSINO, CLAUDIO
Relatore Prof. GIANNONI, ALBERTO
Membro Prof. RECCHIA, FABIO ANASTASIO
Membro Prof. LIONETTI, VINCENZO
Membro Dott.ssa durante, angela
Membro Prof.ssa ANGELONI, DEBORA
Membro Prof. EMDIN, MICHELE
Relatore Prof. GIANNONI, ALBERTO
Membro Prof. RECCHIA, FABIO ANASTASIO
Membro Prof. LIONETTI, VINCENZO
Membro Dott.ssa durante, angela
Membro Prof.ssa ANGELONI, DEBORA
Membro Prof. EMDIN, MICHELE
Parole chiave
- diastolic function
- echocardiography
- heart failure
- prognosis
- pulmonary capillary wedge pressure
Data inizio appello
17/12/2024;
Disponibilità
parziale
Riassunto analitico
Background: A recently validated echocardiographic algorithm for estimating pulmonary capillary wedge pressure (ePCWP) and pulmonary vascular resistance (ePVR) has shown strong prognostic accuracy compared to right heart catheterization in heart failure (HF) patients with left ventricular ejection fraction (LVEF) <50%.
Objective: This study aimed at evaluating the prognostic relevance of longitudinal changes in ePCWP among HF patients.
Methods: 254 HF outpatients (age 71±12 years, 76% male, 35% with atrial fibrillation, baseline LVEF 34±9%, baseline ePCWP 16±5 mmHg) who underwent two echocardiographic studies 12±3 months apart were included in the study. Patients were followed for a composite endpoint of cardiac death or HF hospitalization.
Results: Overall, at the time of second echocardiographic evaluation, improvements were observed in NYHA class, natriuretic peptides, and systolic-diastolic function parameters (all p<0.01). Optimal HF medical therapy was achieved or maintained in 19% and 52% of patients, respectively. Patients with increased ePCWP from the first to second echocardiography exhibited worse NYHA class, adverse cardiac remodelling, more pronounced systolic-diastolic dysfunction, and elevated neurohormonal activation (all p<0.05). Changes in HF life-saving medications or diuretic therapy did not differ significantly when stratifying patients according to ePCWP variations (increased, decreased, stable). Over a median follow-up of 57 (34-72) months, ePCWP changes stratified patients for the risk of the primary endpoint (Log-Rank 42, p<0.001). A 3-mmHg increase retained prognostic accuracy in the entire cohort and in patients with persistently elevated ePCWP. At adjusted regression analysis, both basal ePCWP values and an increase >3 mmHg over time were independent predictors of the primary endpoint (p=0.016 and p=0.024, respectively). A model including basal ePCWP and its longitudinal increase over 3 mmHg outperformed LVEF, natriuretic peptides, and current diastolic dysfunction grading reassessments over time (p<0.001).
Conclusion: Longitudinal changes in ePCWP provide significant clinical and prognostic information beyond baseline values in a cohort of HF patients with LVEF <50%.
Objective: This study aimed at evaluating the prognostic relevance of longitudinal changes in ePCWP among HF patients.
Methods: 254 HF outpatients (age 71±12 years, 76% male, 35% with atrial fibrillation, baseline LVEF 34±9%, baseline ePCWP 16±5 mmHg) who underwent two echocardiographic studies 12±3 months apart were included in the study. Patients were followed for a composite endpoint of cardiac death or HF hospitalization.
Results: Overall, at the time of second echocardiographic evaluation, improvements were observed in NYHA class, natriuretic peptides, and systolic-diastolic function parameters (all p<0.01). Optimal HF medical therapy was achieved or maintained in 19% and 52% of patients, respectively. Patients with increased ePCWP from the first to second echocardiography exhibited worse NYHA class, adverse cardiac remodelling, more pronounced systolic-diastolic dysfunction, and elevated neurohormonal activation (all p<0.05). Changes in HF life-saving medications or diuretic therapy did not differ significantly when stratifying patients according to ePCWP variations (increased, decreased, stable). Over a median follow-up of 57 (34-72) months, ePCWP changes stratified patients for the risk of the primary endpoint (Log-Rank 42, p<0.001). A 3-mmHg increase retained prognostic accuracy in the entire cohort and in patients with persistently elevated ePCWP. At adjusted regression analysis, both basal ePCWP values and an increase >3 mmHg over time were independent predictors of the primary endpoint (p=0.016 and p=0.024, respectively). A model including basal ePCWP and its longitudinal increase over 3 mmHg outperformed LVEF, natriuretic peptides, and current diastolic dysfunction grading reassessments over time (p<0.001).
Conclusion: Longitudinal changes in ePCWP provide significant clinical and prognostic information beyond baseline values in a cohort of HF patients with LVEF <50%.
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