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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
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
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15. Valvular Heart Disease
16. Infective Endocarditis
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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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Abstract
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Prognostic predictors of exercise echocardiography in asymptomatic severe aortic stenosis
Session:
Posters 4 - Écran 05 - Doença Valvular
Speaker:
Rita Carvalheira dos Santos
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:
Rita Carvalheira Dos Santos ; Sofia Alegria; Paula Fazendas; Ana I. Marques; Ana Rita F. Pereira; LILIANA LOPES; Marco Quadrado; Ângela Manuel; Ana Francisco; Dra. Inês Cruz; Ana Almeida; Isabel João; Carlos Cotrim; Helder Pereira
Abstract
<p><strong>Introduction</strong>: The management and clinical decision making in asymptomatic patients with severe aortic stenosis (AS) remains a challenge. Improved life expectancy has led to an increasing number of elderly patients with this condition, in whom the symptoms are harder to evaluate, not only because of their comorbidities but also because they may reduce their level of physical activity and be unaware of subtle changes in effort tolerance. Exercise stress echocardiography may further unmask a subset of asymptomatic patients who are at high risk of cardiac events and would benefit from an earlier intervention. <br /> <br /> <strong>Purpose</strong>: We sought to assess incremental prognostic utility of exercise echocardiography, with special emphasis on functional capacity and its impact in mortality. <br /> <br /> <strong>Methods</strong>: We performed a retrospective analysis of the patients with asymptomatic severe aortic stenosis undergoing exercise echocardiography between 2011 and 2017 at our institution. Exercise protocols used included the Bruce protocol and its modified version. <br /> <br /> <strong>Results</strong>: A total of 50 patients with asymptomatic severe aortic stenosis were included in this analysis (mean age 70 +/- 8.8 years; 52% female gender; 27.5 mean body-mass index; 12% smokers or former smokers; 74% hypertension; 44% diabetes; 76% dyslipidemia; 24% coronary artery disease; 6% ischemic stroke; 14% atrial fibrillation). The average time of the test was 7min +/-2.9 and the mean maximal metabolic equivalents (METs) achieved was 3.6 +/- 2.7. 46% of this cohort were symptomatic and did not achieve 85% of the maximum expected cardiac frequency - two patients due to chest pain with signs of ischemia, one patient due to a second degree AV block, and the remaining due to dyspnea and weariness. The mean-gradient at rest was 32mmHg, the peak exercise mean-gradient was 50mmHg and 61% increased the mean gradient above 18mmHg (51% above 20mmHg). No major complications were recorded. 26% were submitted to aortic valve replacement. The overall mortality was 16%, with a mean follow-up of 895 +/-687 days. The functional capacity was related with the mortality – the patients that didn’t achieve at least 7 METs had higher mortality rates (29% vs 3.2%, p=0.015). Predictors of lower functional capacity were age, female gender and body mass index. The increased gradient > 18mmHg or 20mmHg did not correlate with higher mortality rates. <br /> <br /> <strong>Conclusions</strong>: These findings highlight additional parameters that could assist in identifying a high risk group of asymptomatic patients with severe AS. The presence of lower functional capacity might be an additional parameter to identify those patients who could benefit the most from aggressive monitoring and early intervention.</p>
Slides
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