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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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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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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
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12. Coronary Artery Disease (Chronic)
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14. Acute Cardiac Care
15. Valvular Heart Disease
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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25. Interventional Cardiology
26. Cardiovascular Surgery
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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
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Stress echocardiography in valvular heart disease: adverse events and their prognostic value
Session:
Posters 2 - Écran 07 - Doença Valvular
Speaker:
Sofia Alegria
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:
Posters
FP Number:
---
Authors:
Sofia Alegria; Rita Santos; Ana I. Marques; Ana Catarina Gomes; Ana Rita F. Pereira; Daniel Sebaiti; Dra. Inês Cruz; Ana Almeida; Isabel João; Otilia Ferreira Simões ; Paula Fazendas; Helder Pereira
Abstract
<p>Introduction: Stress echocardiography (SE) is a widely available, low-cost, imaging modality which is becoming increasingly recognized as a valuable tool in the assessment of patients with valvular heart disease (VHD). SE not only identifies high-risk features that indicate need for early surgery, but it also provides useful information regarding risk stratification and long-term outcome, allowing the tailoring of monitoring frequency. Because of the increase in its utilization it is critical to know the safety of the exam.</p> <p>Purpose: Characterize the occurrence of adverse events (AE) in patients with VHD submitted to SE, and their prognostic implications.</p> <p>Methods: Retrospective analysis of SE exams (both exercise (EE) and dobutamine (DE) echocardiograms) performed in a single center during a 6-year-period (June 2011-May 2017). AE were recorded and classified as severe (death, myocardial infarction, acute pulmonary edema, ventricular arrhythmias, asystole, and atrioventricular block) or minor (ischemia, angina, blood pressure drop, and syncope).</p> <p>Results: 126 SE exams (age 67±12 years, 52.4% males) were included. 14.4% of the patients were in NYHA class III/IV, 27.2% had coronary artery disease and 36.2% AF. The left ventricle ejection fraction was 43±20%. 60% of the exams were performed due to aortic stenosis, 20% mitral stenosis, 12.8% mitral regurgitation, 5.6% aortic regurgitation, 0.8% combined mitral disease and 0.8% tricuspid regurgitation. The SE exams were performed to determine the severity of VHD (67.2%), to evaluate pulmonary artery pressure (34.4%), and to assess symptoms (24.6%).</p> <p>79.4% were EE (79% with modified Bruce protocol, and the remaining with classic Bruce protocol) and 20.6% DE echocardiograms. The mean duration of EE exams was 7.3±3.2 minutes, maximum predicted heart rate 84±16% and the metabolic equivalents achieved were 6.6±2.7.</p> <p>AE occurred in 12.7% (n=16) and severe AE in 2.4% (1.6% non-sustained ventricular tachycardia, 0.8% Mobitz II atrioventricular block). There were no deaths. The occurrence of severe events was associated with ST depression and frequent ventricular premature beats on basal ECG (OR 60.0, 95% CI 2.7-1337.4, p<0.001, and OR 240.0, 95% CI 10.8-5349.6, p<0.001, respectively).</p> <p>During follow-up (895±687 days), 32.1% of the patients were submitted to valve intervention (71.4% surgery, the remaining transcatheter). 1-year mortality was 5.1%, and overall mortality 12.7%.</p> <p>The occurrence of severe AE was associated with 1-year mortality (33.3 vs. 4.4%; p=0.025), while the occurrence of any AE was associated with a shorter survival time (109±13 vs. 789±556 days; p=0.001).</p> <p>Conclusions: SE, both exercise and pharmacological, plays a vital and expanding role in the management of patients with VHD. This modality is safe, identifies high-risk features that indicate the need for early surgery and also provides prognostic information. </p>
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