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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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01. History of Cardiology
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07. Syncope and Bradycardia
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32. Cardiovascular Nursing
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Prognostic value of left atrial strain in patients with rheumatic mitral stenosis
Session:
CO 17 - Doença Valvular
Speaker:
Filipa Castro
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.3 Valvular Heart Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Filipa Castro; Olga Azevedo; Mário Lourenço; Lucy Calvo; Margarida Oliveira; Marina Pereira Fernandes; Sérgio Machado Leite; Isabel Oliveira; António Lourenço
Abstract
<p><strong>Introduction</strong>: Rheumatic mitral stenosis (RMS) carries a high risk of cardiovascular (CV) events. The prognostic value of atrial strain parameters is not established in patients with RMS.<br /> <strong>Aim: </strong>To assess left atrial (LA) function using strain analysis by speckle tracking in patients with RMS. To evaluate the usefulness of LA strain for the prediction of adverse CV events in patients with RMS.<br /> <strong>Methods:</strong> We included 44 patients with mild to severe RMS, in sinus rhythm. All subjects underwent transthoracic echocardiogram, including evaluation of PALS (Peak atrial longitudinal strain), PACS (Peak atrial contraction strain) and LA contraction strain index (LA CSI ratio PACS/PALS x100) by speckle tracking. PALS was measured at the end of the reservoir phase and PACS was measured just before the start of the active atrial contractile phase. The averages of PALS and PACS were obtained from the 12 LA segments at apical 4 and 2 chamber views. Demographic data, clinical and electrocardiographic findings were collected to identify predictors of prognosis. We defined a combined endpoint of<br /> CV events, composed by hospitalization, atrial fibrillation, percutaneous valvuloplasty, mitral valve replacement and pulmonar hypertension.<br /> <strong>Results: </strong>Patients were predominantly females (86,4%), with mean age of 59±12 years and a low PALS (17.5 ± 7.3) and PACS (9.5±4.9).<br /> Hospitalization occurred in 25% of cases.<br /> Mitral valve replacement was performed in 11,4% of cases. Pulmonary hypertension developed in 27,3% of patients and atrial fibrillation in 20,5%. The combined endpoint of CV events occurred in 31.8% of cases.<br /> Multivariate regression analysis identified PACS as an independent predictor of the combined endpoint of CV events (p=0,013), but also of hospitalization (p=0,039), pulmonary hypertension (p=0,022) and atrial fibrillation (p=0.024).<br /> The cutoff value of PACS that predicts hospitalization is 18, with a sensitiviy of 90% and a specificity of 55%, and an area under the curve of 0,702 (p=0.046).<br /> <strong>Conclusion</strong>: In this study, PACS was an important independent predictor of CV events in patients with RMS.</p>
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