INCIDENTAL RIGHT VENTRICULAR ABNORMALITIES ON SINGLE PHOTON EMISSION CT SCAN SIGNIFICANTLY PREDICTS DEVELOPMENT OF PULMONARY HYPERTENSION IN BLACK FEMALES

Abstract

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Single Photon Emission Computed Tomography (SPECT) imaging is a diagnostic tool used to risk-stratify patients presenting with chest pain for myocardial ischemia. While SPECT abnormalities of the right ventricle (RV) are known to correlate with invasive hemodynamic measures of disease severity and prognosis in patients with pulmonary hypertension (PH), the prognostic significance of isolated RV abnormalities on SPECT studies in black females who do not carry a PH or cardiac diagnosis is unknown. METHODS: This was a retrospective study. Using the electronic medical record search engine (EMERSE) tool, we identified 12,000 SPECT studies completed at our center between 1/1/07 and 1/1/20. After excluding studies with abnormalities of left ventricular perfusion, elevated cardiac risk, and previous diagnoses of PH, and focusing on black females, we identified 943 unique studies for analysis, and categorized them by the presence or absence of RV abnormalities, including hypertrophy, dilation, or increased uptake. Patient characteristics, including age and body mass index (BMI) at the time of index SPECT study (time zero), were obtained from the medical record, and patients were followed until either an event occurred or the study period ended (2/1/20). The primary outcome was mortality, secondary outcomes included hospital admission and a diagnosis of PH, defined as an estimated right ventricular systolic pressure (RVSP) > 35 mmHg on echocardiogram. Patients lost to follow-up were censored at the time of their last clinical encounter. Multivariable Cox Proportional Hazards models and logistic regression models, adjusted for age and BMI, were used in the analysis. This study was reviewed and approved by the UC Institutional Review Board (IRB 2019-1282). RESULTS: A total of 943 black females were included in this analysis, with a median age of 52 years and a median BMI of 33. The median duration of follow-up was 10.5 years, and 10.3% of patients died during the follow-up period. In the full cohort, RV abnormalities were present in 4% of patients, and PH was subsequently diagnosed in 18.3% of patients during follow-up (median RVSP 45 mmHg). Age was the only significant predictor of readmission (HR 1.01, p=0.007) or mortality (HR 1.07, p=1E-14). RV abnormalities (OR 3.2, p=0.001), age (OR 1.04, p=4E-8), and BMI (OR 1.02, p=0.004) all significantly and independently predicted development of PH. CONCLUSIONS: RV abnormalities incidentally found on otherwise normal SPECT studies were significantly predictive of the development of PH in black females, even after adjustment for age and BMI. The combination of these factors may be useful in risk-stratification of black female patients for PH, and identify high-risk patients who would benefit from a more comprehensive workup for PH and serial echocardiographic evaluation. CLINICAL IMPLICATIONS: RV abnormalities on SPECT imaging may help risk-stratify black females for PH DISCLOSURES: no disclosure on file for Rachel Baker; Chair of a Committee relationship with PHA Please note: PHA Medically Led Sessions, PHA Preceptorship Added 05/22/2020 by Jean Elwing, source=Web Response Removed 05/22/2020 by Jean Elwing, source=Web Response Educator relationship with PH CME Programs - PHA, Simply Speaking, Impact PH Please note: Intermittent, Ongoing Added 05/22/2020 by Jean Elwing, source=Web Response, value=Honoraria Principal Investigator relationship with Actelion, Arena, Reata, United Therapeutics Please note: Ongoing - University is Paid Directly Added 05/22/2020 by Jean Elwing, source=Web Response, value=Grant/Research Support Advisory Committee Member relationship with United Therapeutics Please note: $5001 - $20000 Added 06/05/2020 by Jean Elwing, source=Web Response, value=Consulting fee Principal Investigator relationship with Lung LLC, Liquidia, Phase Bio, Complexa, Gossamer Bio Please note: Ongoing - University is Paid Directly Added 05/22/2020 by Jean Elwing, source=Web Response, value=Grant/Research Support Member of a Committee relationship with PHA Please note: PHA Education Committee Added 05/22/2020 by Jean Elwing, source=Web Response Removed 05/22/2020 by Jean Elwing, source=Web Response Advisory Committee Member relationship with Liquidia, Acceleron Please note: $1001 - $5000 Added 06/05/2020 by Jean Elwing, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Acceleron Please note: $5001 - $20000 Added 06/05/2020 by Jean Elwing, source=Web Response, value=Consulting fee Removed 06/05/2020 by Jean Elwing, source=Web Response Grant - Entelligence Award relationship with Actelion Please note: >$100000 Added 05/25/2020 by Arun Jose, source=Web Response, value=Grant/Research Support No relevant relationships by Francis McCormack, source=Web Response No relevant relationships by Humna Abid Memon, source=Web Response