Riding The Storm: Utilizing VA-ECMO As A Bridge To Recovery In A Patient With Fulminant Necrotizing Eosinophilic Myocarditis
HFSA ePoster Library. Tanveer Ud Din M. 09/10/21; 343570; 328
Disclosure(s): The authors have no relevant disclosures
Dr. Mian Tanveer Ud Din
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Abstract
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Introduction: Systemic Arterial Pulsatility Index, (SAPi), [systemic pulse pressure]/Left ventricular end diastolic pressure, (LVEDP)] has emerged as a useful prognostic tool. We evaluated the predictive value of SAPi in pre-transcatheter aortic valve replacement (TAVR) patients using measurements from cardiac catheterization (SAPi-Cath) vs trans-thoracic echocardiography (SAPi-TTE).
Methods: SAPi was calculated using two methods. SAPi-Cath, using invasive hemodynamics while SAPi-TTE using Nagueh formula (PCWP = 1.24 X (E/e’) +1.9), as surrogate for LVEDP. Pulse pressure was obtained from the blood pressure taken at the time of the TTE. Correlational and hierarchical comparisons of SAPi with pre-TAVR five-meter walk times (5MWT) were made using R software.
Results: Among 110 pre-TAVR patients (mean age 77.3, 56% female), the median SAPi-Cath was 3.05 (IQR 2.22-3.94). In 94/110 (85.5%) patients with a 5MWT and SAPi-Cath assessment, the pre-TAVR SAPi-Cath was significantly associated with the pre-TAVR 5MWT (r=0.32, p=0.0015); shown in Figure 1. In 74/110 (67.3%) patients who had a pre-TAVR TTE to calculate TTE-SAPi, the correlation was not significant (r=0.144, p=0.219). An exploratory analysis based on machine learning with hierarchical clustering demonstrated two distinct clusters (Figure 2); group A had 79 patients, and group B had 15 patients. The 5MWT (14.1 [B] v. 5.8 [A], p=0.0002) and the SAPi-Cath (4.9 [B] v 2.8 [A]; p<0.0001) were substantially more favorable in Group B, while SAPi-TTE was similar in the two groups (p=0.36). All four patients who died during follow-up were in cluster A (no deaths in cluster B).
Conclusion: SAPi-Cath was significantly associated with five-meter walk time in pre-TAVR patients. SAPi derived from TTE was not associated with 5MWT, nor was it correlated with SAPi-cath. Further studies on the applications of SAPi in risk stratification of patients are warranted.
Methods: SAPi was calculated using two methods. SAPi-Cath, using invasive hemodynamics while SAPi-TTE using Nagueh formula (PCWP = 1.24 X (E/e’) +1.9), as surrogate for LVEDP. Pulse pressure was obtained from the blood pressure taken at the time of the TTE. Correlational and hierarchical comparisons of SAPi with pre-TAVR five-meter walk times (5MWT) were made using R software.
Results: Among 110 pre-TAVR patients (mean age 77.3, 56% female), the median SAPi-Cath was 3.05 (IQR 2.22-3.94). In 94/110 (85.5%) patients with a 5MWT and SAPi-Cath assessment, the pre-TAVR SAPi-Cath was significantly associated with the pre-TAVR 5MWT (r=0.32, p=0.0015); shown in Figure 1. In 74/110 (67.3%) patients who had a pre-TAVR TTE to calculate TTE-SAPi, the correlation was not significant (r=0.144, p=0.219). An exploratory analysis based on machine learning with hierarchical clustering demonstrated two distinct clusters (Figure 2); group A had 79 patients, and group B had 15 patients. The 5MWT (14.1 [B] v. 5.8 [A], p=0.0002) and the SAPi-Cath (4.9 [B] v 2.8 [A]; p<0.0001) were substantially more favorable in Group B, while SAPi-TTE was similar in the two groups (p=0.36). All four patients who died during follow-up were in cluster A (no deaths in cluster B).
Conclusion: SAPi-Cath was significantly associated with five-meter walk time in pre-TAVR patients. SAPi derived from TTE was not associated with 5MWT, nor was it correlated with SAPi-cath. Further studies on the applications of SAPi in risk stratification of patients are warranted.
Introduction: Systemic Arterial Pulsatility Index, (SAPi), [systemic pulse pressure]/Left ventricular end diastolic pressure, (LVEDP)] has emerged as a useful prognostic tool. We evaluated the predictive value of SAPi in pre-transcatheter aortic valve replacement (TAVR) patients using measurements from cardiac catheterization (SAPi-Cath) vs trans-thoracic echocardiography (SAPi-TTE).
Methods: SAPi was calculated using two methods. SAPi-Cath, using invasive hemodynamics while SAPi-TTE using Nagueh formula (PCWP = 1.24 X (E/e’) +1.9), as surrogate for LVEDP. Pulse pressure was obtained from the blood pressure taken at the time of the TTE. Correlational and hierarchical comparisons of SAPi with pre-TAVR five-meter walk times (5MWT) were made using R software.
Results: Among 110 pre-TAVR patients (mean age 77.3, 56% female), the median SAPi-Cath was 3.05 (IQR 2.22-3.94). In 94/110 (85.5%) patients with a 5MWT and SAPi-Cath assessment, the pre-TAVR SAPi-Cath was significantly associated with the pre-TAVR 5MWT (r=0.32, p=0.0015); shown in Figure 1. In 74/110 (67.3%) patients who had a pre-TAVR TTE to calculate TTE-SAPi, the correlation was not significant (r=0.144, p=0.219). An exploratory analysis based on machine learning with hierarchical clustering demonstrated two distinct clusters (Figure 2); group A had 79 patients, and group B had 15 patients. The 5MWT (14.1 [B] v. 5.8 [A], p=0.0002) and the SAPi-Cath (4.9 [B] v 2.8 [A]; p<0.0001) were substantially more favorable in Group B, while SAPi-TTE was similar in the two groups (p=0.36). All four patients who died during follow-up were in cluster A (no deaths in cluster B).
Conclusion: SAPi-Cath was significantly associated with five-meter walk time in pre-TAVR patients. SAPi derived from TTE was not associated with 5MWT, nor was it correlated with SAPi-cath. Further studies on the applications of SAPi in risk stratification of patients are warranted.
Methods: SAPi was calculated using two methods. SAPi-Cath, using invasive hemodynamics while SAPi-TTE using Nagueh formula (PCWP = 1.24 X (E/e’) +1.9), as surrogate for LVEDP. Pulse pressure was obtained from the blood pressure taken at the time of the TTE. Correlational and hierarchical comparisons of SAPi with pre-TAVR five-meter walk times (5MWT) were made using R software.
Results: Among 110 pre-TAVR patients (mean age 77.3, 56% female), the median SAPi-Cath was 3.05 (IQR 2.22-3.94). In 94/110 (85.5%) patients with a 5MWT and SAPi-Cath assessment, the pre-TAVR SAPi-Cath was significantly associated with the pre-TAVR 5MWT (r=0.32, p=0.0015); shown in Figure 1. In 74/110 (67.3%) patients who had a pre-TAVR TTE to calculate TTE-SAPi, the correlation was not significant (r=0.144, p=0.219). An exploratory analysis based on machine learning with hierarchical clustering demonstrated two distinct clusters (Figure 2); group A had 79 patients, and group B had 15 patients. The 5MWT (14.1 [B] v. 5.8 [A], p=0.0002) and the SAPi-Cath (4.9 [B] v 2.8 [A]; p<0.0001) were substantially more favorable in Group B, while SAPi-TTE was similar in the two groups (p=0.36). All four patients who died during follow-up were in cluster A (no deaths in cluster B).
Conclusion: SAPi-Cath was significantly associated with five-meter walk time in pre-TAVR patients. SAPi derived from TTE was not associated with 5MWT, nor was it correlated with SAPi-cath. Further studies on the applications of SAPi in risk stratification of patients are warranted.
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