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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
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
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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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Stroke volume variation in patients with severe aortic stenosis undergoing valvular intervention
Session:
Posters 1 - Écran 09 - Ecocardiografia
Speaker:
Gustavo Sá Mendes
Congress:
CPC 2018
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Gustavo Sá Mendes; Sérgio Madeira; Pedro Freitas; Catarina Brízido; Franscisco Fernandes Gama; Maria João Andrade; Miguel Mendes
Abstract
<p><strong>Background: </strong>Echocardiographic determined index stroke volume (iSV) is of paramount importance for aortic stenosis grading and characterization. The aim of this study was to assess the variation of index stroke volume after valvular intervention and its impact on survival.</p> <p><strong>Methods: </strong>Single centre retrospective analysis of 280 patients undergoing transcatheter aortic valve implantation (TAVI) and surgical valve replacement (SVR) between 2009 and 2017. All patients had a baseline and post procedural echocardiographic evaluation according to local protocol for the assessment of aortic valve disease, including measurement of LVOT diameter and calculation of haemodynamic derived parameters.</p> <p>Patients were categorized in two groups according to iSV variation from baseline (< 35 ml/m<sup>2</sup> or ≥ 35ml/m<sup>2</sup>). Group A included patients with low iSV after the procedure (those who remained with low iSV plus patients who had a baseline iSV ≥ 35 ml/m<sup>2</sup> and decrease to <35 ml/m<sup>2</sup>); group B comprised patients with iSV ≥ 35 ml/m<sup>2</sup> after the procedure (figure 1).</p> <p>Univariate analysis (using Chi-square, T-student and Mann-Whitney tests) was used to identify variables associated with overall mortality. Cox regression including variables associated with mortality was used to identify independent predictors.</p> <p><strong>Results: </strong>The mean age was 82 ± 7 years, and 58% were female. Eighty six percent underwent TAVI and 14% underwent SVR. The median baseline iSV was 41 IQR [33-50] ml/m<sup>2</sup> and median post procedural SV was 41 [34-49]ml/m<sup>2</sup>, without statistic differences between groups (p=0,139). After intervention, 197 (70,4%) patients remained within the same iSV range, 44 (15,7%) decreased and 39 (13,9%) increased iSV category; ultimately 85 (30,4%) patients had a post procedural iSV < 35ml/m<sup>2</sup> (Group A). There were 70 (26%) deaths at the median follow-up of 2 IQR [0.65-3,2] years. Patients who died had lower left ejection fraction (median 55 IQR [44,7-57] vs 55 IQR [52-65], p= 0,014), higher prevalence of diabetes (41% vs 27%, p=0,035) and lower post-procedural iSV (Group A 24% vs Group B 11 %, p=0,010). On Cox regression, diabetes (HR 2 IC 95% 1.2-3.4) was an independent predictor of mortality and ejection fraction had a protective effect (HR 0.975 IC 95% 0.956 – 0.99); on the other hand post-procedural iSV did not have an impact on survival.</p> <p><strong>Conclusion: </strong>In this population, even though there wasn’t a significant change in stroke volume after valvular intervention, patients with low iSV (baseline or after intervention) had higher mortality. In this study iSV did not show to be an independent predictor of mortality.</p>
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