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CPC 2018
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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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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
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L. Cardiovascular Pharmacology
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Value of cardiac magnetic resonance in myocardial infarction with non-obstructive coronary arteries
Session:
Posters 1 - Écran 07 - Isquemia /SCA
Speaker:
Daniel Seabra De Carvalho
Congress:
CPC 2018
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.3 Acute Coronary Syndromes – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Daniel Seabra De Carvalho; Leonor Marques; Ana Leal Neto; Henrique Guedes; João A. G. Azevedo; Paula Pinto
Abstract
<p><strong>Background: </strong>Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a working diagnosis that should promote a complementary diagnostic evaluation to ascertain the underlying aetiology. Cardiovascular magnetic resonance (CMR) is a key element in differential diagnosis.</p> <p><strong>Purpose:</strong> Evaluate the usefulness of CMR in patients presenting with MINOCA and identify analytical, electrical and imaging differences between the underlying definitive diagnosis.</p> <p><strong>Methods:</strong> A cohort of patients with established criteria for MINOCA (chest pain and/or electrocardiographic changes and troponin elevation, in the absence of significant coronary artery stenosis [normal or stenosis <50% of the vessel diameter on angiography]) and submitted to CMR between 1/2013 and 9/2017 was evaluated. 5 subgroups were defined based on CMR diagnosis: myocarditis (G1), myocardial infarction (G2), <em>Takotsubo </em>syndrome (G3), other diagnosis (G4) and normal CMR (G5). Clinical characteristics, inflammatory and cardiac serum biomarkers, echocardiographic and CMR parameters were analysed.</p> <p><strong>Results: </strong>93 pts were included: G1 29 (31.2%); G2 24 (25.8%); G3 7 (7.5%); G4 12 (12.9%); G5 21 (22.6%); G4 was excluded from analysis, as it comprised heterogeneous group of diagnosis. Differences were found on mean age [lower on G1 (p<0.001; G1 vs G2, p<0.001; G1 vs G3, p=0.003; G1 vs G5, p<0.001)] and gender [male predominance on G1 and G2; female predominance on G3 and G5 (p<0.001; G1 vs G3, p<0.001; G1 vs G5, p=0.001; G2 vs G3, p=0.004)]. No differences were found on cardiovascular risk factors. G1 had higher CPK values [(p=0.008; G1 vs G5 p=0.008)]. On ECG, G3 had higher QTc intervals (p=0.002; G1 vs G3, p=0.002; G2 vs G3, p=0.020; G3 vs G5, p=0.002). On echocardiogram, G2 and G3 had higher prevalence of wall motion abnormalities (p=0.018; G2 vs G5, p=0.012; G3 vs G5, p=0.016). G5 pts had superior delay until CMR realization while G1 performed CMR more often during hospital stay (p=0.031; G1 vs G5, p=0.041). Regarding CMR findings, no LGE was found on G3 (p<0.001) and the number of committed LGE segments was superior in G1 (4.2 vs 2.1, p=0.002).</p> <p><strong>Conclusions: </strong>In this cohort of MINOCA pts, CMR established a definitive diagnosis in 77% of cases. In pts with normal CMR, the delay until scan performance was higher. CMR has an important role in identification of the underlying etiology of MINOCA, and time delays may affect its diagnostic accuracy.</p>
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