|Tipo di tesi||Tesi di laurea magistrale|
|Titolo||VALORE PROGNOSTICO DELLA CAPACITÀ DI LAVORO DEL VENTRICOLO DI DESTRA NEI PAZIENTI CON IPERTENSIONE ARTERIOSA POLMONARE|
|Titolo in inglese||PROGNOSTIC ROLE OF THE RIGHT VENTRICLE WORKLOAD CAPACITY IN PATIENTS WITH PULMONARY ARTERY HYPERTENSION|
|Struttura||Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze|
|Corso di studi||MEDICINA E CHIRURGIA (D.M.270/04)|
|Data inizio appello||2019-07-17|
|Disponibilità||Accessibile via web (tutti i file della tesi sono accessibili)|
INTRODUZIONE:L’ipertensione arteriosa polmonare (IAP) è un gruppo di patologie respiratorie che presentano un aumento della pressione arteriosa polmonare (PAP) e una alterazione dell'attività contrattile del cuore di destra. La prognosi di questi pazienti è difficile da stabilire e i parametri attualmente utilizzati devono essere combinati per poter dare risultati soddisfacenti.
INTRODUCTION: Pulmonary arterial hypertension (PAH) is a lung disease in which the main alteration are the increase in pulmonary arterial pressure (PAP) and the alteration of the right ventricle activity. Currently, the prognosis is estimated combining clinical and haemodynamic parameters in order to increase the prognostic value of all the indexes. PURPOSE: The aim of our study was the evaluation of right ventricle stroke workload index (RVSWI) as a parameter to evaluate patients’ prognosis. RVSWI integrate both RV functionality and alteration of the pulmonary circle. It is known that the RV adaptation to the elevation of PAP. As a consequence, we hypnotize that higher value of RVSWI correlates with better long-term prognosis. On the contrary, patients with lower RVSWI has a worse prognosis. METHODS: We enrolled a series of 96 consecutive patients affected by PAH in Cardiology Department of the Polyclinic Hospital of Modena, from 2008 to 2018. The mean observational follow up period was 62 months (in a range between 24 and 84 months). The majority of patients have PAH associated to other disease. Particularly, 42 patients with systemic sclerosis, 38 patients with hepatic cirrhosis and portal hypertension, 6 patients with congenital heart disease (shunt left-to-right), 4 patients with HIV infection. Only 6 patients were diagnosed as idiopathic PAH. All patients underwent right heart catheterization (RHC) at rest with Swan-Ganz catheter. We recorded different hemodynamic parameters such as mean right atrium pressure (mRAP); systolic, diastolic and mean pulmonary arterial pressure (mPAP); pulmonary capillary wedge pressure (PCWP); heart rate (HR), mixed venous oxygen saturation of the pulmonary artery (SvO2) and cardiac output (CO). Starting from those parameters we calculate: transpulmonary gradient PCWP-mPAP; Pulmonary vascular resistance (PVR) TPG/ CO; CO was indexed by body surface area (BSA) and expressed as cardiac index (CI); stroke volume index (SVI) CI/HRx1,000; RVSWI SVI x (mPAP-mRAP) x 0.0136. RESULTS: During the follow-up (from January 2008 to January 2018) period 56 patients were died (58.3%). It has been noticed that when RVSWI increased the mortality rate decreased. Particularly, a reduction of mortality of 8% has been correlate with an increase of one unite of RVSWI. Comparing RVSWI with the current well-known prognostic parameters such as WHO functional class, clinical parameters and other hemodynamic value, it was observed a better predictive prognostic value capability. WHO FC, mPAP, SvO2 and RVSWI had demonstrated a significant correlation to all-causes mortality. Chi-squared model increase when at the base line evaluation is considered also RVSWI. CONCLUSIONS: We found a significative association between mortality and RV workload capacity measured during the right heart catheterization at the moment of diagnosis. According to our hypothesis, results of the present study showed that an increased RVSWI was associated with a reduced risk of long-term mortality. Clinical parameters and other hemodynamic parameters are currently the most important parameters by which the patients’ prognosis is determined. Comparing those values to RVSWI it has been possible to demonstrate an increasing chi-squared value and a statistically significantly p-value. Moreover, RVSWI alone has demonstrated a direct correlation with long-term patients’ survival. Thus, higher value of RVSWI associates with a better prognosis if compared with those patients with lower RVSWI value.