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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
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
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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
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Predictors of myocarditis versus myocardial infarction in patients with non-obstructive coronary disease
Session:
Posters 2 - Écran 09 - Miocárdio e Pericárdio
Speaker:
Leonor Marques
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.3 Myocardial Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Leonor Marques; Daniel Seabra De Carvalho; Ana Leal Neto; Henrique Guedes; Aurora Andrade; Paula Pinto
Abstract
<p><strong>Background: </strong>Acute chest pain and elevation of troponin in patients (pts) with non-obstructive coronary disease represents a clinical challenge, often with an under recognized diagnosis and suboptimal treatment. Acute myocarditis (AM) and myocardial infarction with non-obstructive coronary disease (MI) represent two of the most frequent diagnosis in these pts, with treatment and prognosis implications.</p> <p><strong>Purpose:</strong> Describe a cohort of pts submitted to CMR with a clinical suspicion of AM or MI, in which the diagnosis was confirmed by this technique and find clinical and paraclinical predictors of diagnosis.</p> <p><strong>Methods:</strong> We retrospectively analyzed a cohort of pts submitted to CMR between 1/2013 and 9/2017 with a clinical suspicion of AM or MI with non-obstructive coronary disease on angiogram (no stenosis or stenosis <50% of the vessel diameter). Only pts with a final CMR diagnosis of AM or MI were included. Clinical characteristics [age, sex, body mass index (BMI), arterial hypertension (AHT), diabetes mellitus, dyslipidemia], inflammatory (leukocytosis, c reactive protein) and cardiac (troponin I, brain natriuretic peptide) biomarkers, electrical changes on admission [normal ST-T segment, ST segment elevation, T wave inversion, QRS length], echocardiographic [wall motion abnormalities (WMA), left ventricle ejection fraction (LVEF)] and CMR [indexed cardiac output (iCO), LVEF, late gadolinium enhancement (LGE)] parameters were compared.</p> <p><strong>Results:</strong> 76 pts were included, 50 with AM and 26 with MI. We found no differences on gender distribution, with a younger age in AM group (38.6±15.4 vs 58.1±16.2 years, p<0.001). AM pts had lower BMI (25.6±4.3 vs 27.7±4.2 kg/m<sup>2</sup>, p=0.043) and AHT prevalence (12.0 vs 53.8%, p<0.001). No differences were found on analytical or ECG findings. On echocardiogram, AM pts had lower prevalence of WMA (40.0 vs 69.2%, p=0.016), with no differences on LVEF. On CMR, a higher iCO was found on AM (3.5±0.8 vs 3.1±0.8 mL/m2, p=0.03), with lower prevalence of WMA (4.1 vs 73.1%, p<0.001); on LGE, differences were found on its distribution pattern (p<0.001), with a higher mean number of touched segments in AM pts (3.9±2.3 vs 2.1±2.3, p<0.001).</p> <p><strong>Conclusions: </strong>In the analyzed cohort, AM pts presented lower mean age, BMI and AHT prevalence, with less WMA detected both on echocardiogram and CMR; AM pts also had a higher number of segments with LGE and iCO on CMR. The integration of these clinical and paraclinical data may aid in differential diagnosis of these two entities.</p>
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