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• W4387256217 abstract "SESSION TITLE: Pulmonary Vascular Disease Posters 5 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: Right heart catheterization (RHC) is required for the diagnosis and hemodynamic classification of pulmonary hypertension (PH). The diagnosis of post-capillary and combined pre- and post-capillary PH requires a pulmonary artery wedge pressure (PAWP) ≥15 mmHg. However, in obese patients with increased intrathoracic pressure, the PAWP may be spuriously elevated. Since body mass index (BMI) does not have a good correlation with intrathoracic pressure in obese patients, we sought to identify variables that could support the placement of an esophageal balloon to determine the intrathoracic pressure. METHODS: Informed consent was obtained from all patients. We retrospectively investigated clinical, spirometric, echocardiographic, radiographic and hemodynamic determinations in PH patients with obesity (BMI ≥ 30 kg/m2) who underwent RHC with simultaneous esophageal pressure (Pes) determination. Fat volume analysis on CT of the chest was performed using intuition volume-rendered imaging software (Terrarecon, Foster City, CA). RESULTS: We included 89 patients of which 59% were women. The mean age was 59 ± 13 years, and the mean BMI was 46.2 ± 10.6 kg/m2. The right atrial pressure (RAP), mean pulmonary artery pressure (mPAP) and PAWP at end-expiration (PAWP-ee) were 17.5 ± 6.6 mmHg, 44.3 ± 13.1 mmHg and 25.0 ± 7.2 mmHg, respectively. The Pes at end-expiration (Pes-e) and averaged across the respiratory cycle (Pes-a) were 13.1 ± 5.1 mmHg and 9.2 ± 4.2 mmHg, respectively. PAWP adjusted by Pes was 11.9 ± 6.8 mmHg. The RAP was directly associated with Pes-e and Pes-a (r: +0.39, p<0.001 and r: 0.38, p=0.001, respectively). The PAWP-ee was directly associated with Pes-e and Pes-a (r: +0.43, p<0.001 and r: 0.37, p=0.001, respectively). The PAW-ee drop from supine to sitting position was directly associated with Pes-e (r: +0.26, p=0.02). T8 subcutaneous area and the ratio of T8 subcutaneous area / thoracic area were associated with Pes-a (r: 0.24, p=0.045 and r: 0.26, p=0.03, respectively). The best variables in multivariable models to predict Pes-e were the combination of RAP and the drop from PAWP from supine to sitting (R: 0.45) or the PAWP-ee alone (R: 0.43). The best multivariable model for predicting Pes-a included PAWP-ee and T8 subcutaneous area (R: 0.43). CONCLUSIONS: A higher RAP, PAWP and a more pronounced drop in PAWP from supine to sitting position should alert the presence of higher Pes-ee. A larger T8 subcutaneous area was the only non-invasive variable with a significant association with Pes-a. CLINICAL IMPLICATIONS: In patients with higher Pes-ee, the PAWP might be spuriously elevated which may lead to misclassification of their PH. Further studies are needed to identify if a higher RAP, higher PAWP, a more pronouced drop in PAWP from supine to sitting position, and a larger T8 subcutaneous area can accurately predict a higher Pes-ee. Such patients should have their Pes measured during RHC to optimally adjust their PAWP. DISCLOSURES: Consultant relationship with IngMar Medical Please note: 2020 to present Added 03/22/2023 by Robert Chatburn, source=Web Response, value=Consulting fee Consultant relationship with Inovytec Please note: 2020 to present Added 03/22/2023 by Robert Chatburn, source=Web Response, value=Consulting fee Consultant relationship with Ventis Please note: 2020 to present Added 03/22/2023 by Robert Chatburn, source=Web Response, value=Consulting fee No relevant relationships by Umur Hatipoglu No relevant relationships by Ghaleb Khirfan No relevant relationships by Eduard Krishtopaytis No relevant relationships by James Lane No relevant relationships by Gaurav Manek No relevant relationships by Deborah Paul No relevant relationships by Apostolos Perelas No relevant relationships by Adriano Tonelli No relevant relationships by David Toth No relevant relationships by Shaoxiong Zhang" @default.
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• W4387256217 date "2023-10-01" @default.
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• W4387256217 title "CAN WE PREDICT AN INCREASED INTRATHORACIC PRESSURE IN OBESE PATIENTS WITH HIGH PULMONARY ARTERY WEDGE PRESSURE?" @default.
• W4387256217 doi "https://doi.org/10.1016/j.chest.2023.07.3791" @default.
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