Ο ρόλος του δεξιού καρδιακού καθετηριασμού στην εκτίμηση της επίδρασης της ειδικής φαρμακευτικής αγωγής σε ασθενείς με προτριχοειδική πνευμονική υπέρταση Σ.Α. Μουράτογλου, Α. Αρβανιτάκη, Ι. Δουνδουλάκης, Χ. Φελουκίδης, Μ.Α. Μπασμπάνη, Μ. Τουμπουρλέκα, Β. Γροσομανίδης, Δ. Εκκλησίαρχος, Π. Κλιγκάτσης, Α. Τζίκας, Γ. Σιάνος, Σ. Χατζημιλτιάδης, Γ. Γιαννακούλας, Χ. Καρβούνης Α’ Καρδιολογική Κλινική ΓΠΝ ΑΧΕΠΑ Θεσσαλονίκης

Conflicts of interest: None

Background I RHC Is the gold standard in PH diagnosis Classifies PH into 2 groups Galie et al, Eur Heart J 2015

Background II Provides information on prognosis SvO2 <65% RAP >8mmHg CI <2ml/min/m2

Background IIΙ Limited number of clinical trials with hemodynamic endpoints (CHEST-1, PATENT-1, SERAPHIN, ATHENA-1, MAESTRO sub-study) Limited follow up period (3 to 6 months) PAH targeted therapies do not improve prognosis-related hemodynamic parameters in most trials

Aim To evaluate the effect of advanced PAH treatment on hemodynamic profile of patients with precapillary PH

Materials and methods – study design Retrospective Non invasive Single center AHEPA university Hospital of Thessaloniki, Outpatient Clinic for Pulmonary Hypertension Time frame October 2014 – February 2017

Materials and methods – patient population >18 years old Age Both male and female Sex Precapillary PH classified as Group 1 and 4 Diagnosis Treatment naive Incident patients After initiation of PAH targeted therapy (regular FU or clinical deterioration) depending on usual care Available FU RHCs

Materials and methods - procedures mRAP CI SVO2 mPAP PAWP PVR CI: thermodilution

Results I – patient population Patients that underwent RHC N=115 No PH N=12 Incident cases of PH N=44 Group I N=13 Patients on treatment N=59 Group IV N=4 No repeat RHC N=27 IPAH 3 CHD-corrected 1 CTD 7 PoPAH 2 Persistent 1 Inoperable 3 Group 1 N=13 Group 4 N=4

Results II – patient population 17 Sex (female) 7 (41%) Time between RHCs (months) 16.3 (9.8-22.2) Age, (years) 61.9±13.1 ΒΜΙ, kg/m2 29.1±4.9

Results II – advanced treatment

Results III – hemodynamic data Baseline Follow up   p mRAP, mmHg 7.0 (3.0 – 25.0) 6.0 (1.0-20.0) 0.11 mPAP, mmHg 50.8±14.2 40.8±13.0 0.001 PAWP, mmHg 12.2±5.5 11.1±3.1 0.28 SVO2, % 65.5±5.2 68.3±9.0 0.19 CI, L/min/m2 2.5± 0.8 2.9 ± 0.9 0.15 PVR, Woods 7.9 (2.5-28.6) 5.4 (2.1-18.7) 0.017 mPAP, mmHg 50.8±14.2 40.8±13.0 0.001 PVR, Woods 7.9 (2.5-28.6) 5.4 (2.1-18.7) 0.017

p = 0.001 mPAP baseline mPAP FU p = 0.19 SvO2 baseline SvO2 FU p = 0.017 p = 0.15 CI baseline CI FU PVR baseline PVR FU

This is real life data showing that advance PH treatment led to Conclusion This is real life data showing that advance PH treatment led to Improvement of mPAP PVR No change in prognostic indexes in PAH In patients with precapillary pulmonary hypertension

Limitations Study design Single center, one arm Small patient population Variety in treatment options

Acknowledgements AHEPA University Hospital Pulmonary Hypertension Unit Thank you