Severity of precapillary pulmonary hypertension: Predictive factor.

BACKGROUND AND OBJECTIVES: Patients with pulmonary arterial hypertension (PAH) require risk assessments for prognosis and appropriate therapy. These assessments need to be improved by incorporating clinical and laboratory data such as the analysis of the right ventricle. We aim to establish echocardiographic morphometric data of the right ventricle and its relationship with the left ventricle, to estimate the hemodynamic severity of precapillary pulmonary hypertension (PHprecapillary). METHODS: This cohort, prospective, observational, and cross-sectional study included 41 consecutive patients with PHprecapillary using echocardiographic study and cardiac catheterization. RESULTS: Patients' mean age was 44.0±16.4 years, and 37 were women (90.2%). Idiopathic PAH was diagnosed in 18 patients (43.9%). The World Health Organization/New York Association functional class was III or IV in 31 patients (75.6%). The ratio of the right to left ventricles (RV/LV) echocardiographic diastolic diameters was associated with pulmonary arterial pressures in cardiac catheterization, with the best cutoff per receiver operating characteristic curve being 0.8 for systolic pressure (sensitivity 90.0%, specificity 78.3%, area under the curve [AUC] 0.882) and mean pressure (sensitivity 60.0%, specificity 95.7%, AUC 0.823). Spearman's correlation (R) of RV/LV echocardiographic ratio and the hemodynamic variables was significant for systolic pressure (R = 0.7015, p < 0.0001), mean pressure (R = 0.6332, p < 0.0001), transpulmonary pressure gradient (R = 0.6524, p < 0.0001), pulmonary vascular resistance (R = 0.6076, p = 0.0021), and pulmonary vascular resistance index (R = 0.6229, p = 0.0014). CONCLUSION: The ratio of RV/LV echocardiographic diastolic diameters contribute to the estimates the hemodynamic severity of precapillary pulmonary hypertension. The best cutoff for this assessment was RV/LV of 0.8.

Construct validity and reliability of the Brazilian version of the Falls Efficacy Scale in patients with COPD.

INTRODUCTION AND OBJECTIVE: The Brazilian version of Falls Efficacy Scale (FES-BR) used to assess the fear of falling, has not yet been validated in patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of the present study was to investigate the construct validity and reliability of the (FES-BR) in patients with COPD. METHODS: A cross-sectional study involving subjects with COPD, aged between 48 and 83 years. Data were collected by two independent and blind assessors. Construct validity was assessed using the Spearman's rank correlation coefficient between FES-BR and Berg Balance Scale, Downton fall risk index, Timed Up and Go Test (TUG), hand-grip strength (HGS), Five Times Sit to Stand Test (FTSST) and 6-Minute Walk Test (6MWT). Reliability was measured by the Cronbach's alpha coefficient, Intraclass Correlation Coefficient (ICC), and Bland-Altman plot. RESULTS: The study included 60 subjects aged 68.3 ±â€¯9.9 years and FEV1 56.0 ±â€¯19.3. The correlations were significantly strong between FES-BR and the Berg Balance Scale (r = -0.66), TUG (r = 0.64), HGS (r = 0.61) and FTSST (r = 0.62); and moderate between FES-BR and the Downton fall risk index (r = 0.38) and the 6MWT (r = -0.48). All correlations had p < 0.001. Intra-rater [ICC = 0.94, (95% CI = 0.91-0.96)] and inter-rater [0.97, (95% CI = 0.97-0.98)] reliability were considered excellent. CONCLUSIONS: The Brazilian version of FES was valid and reliable in assess fear of falling in subjects with COPD.