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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
O. Basic Science
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0 Themes
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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The coronary artery disease prevalence, revascularization patterns and its prognostic impact in a real world valvular heart disease population
Session:
Posters 4 - Écran 05 - Doença Valvular
Speaker:
Luís Morais
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Luís Almeida Morais; Ruben Ramos; Tiago Pereira Da Silva; António Fiarresga; Lidia De Sousa; Ramiro Sá Carvalho; Luis Bernardes; Lino Patrício ; Filipa Silva; Eunice Oliveira; Duarte Cacela; Rui Cruz Ferreira
Abstract
<p><strong>Background</strong>: Patients undergoing heart valve surgery are routinely evaluated for the presence of Coronary Artery Disease (CAD), with the standard practice of combining valve intervention with a revascularization procedure, notably Coronary Artery Bypass Graft (CABG). Old studies suggest rates as high as 50% prevalence of CAD in this population. However, CAD prevalence, its treatment and prognostic implication has been questioned recently.</p> <p><strong>Objectives: </strong>The goal of this study is to evaluate the true prevalence of CAD in a contemporary population with valvular heart disease (VHD) and evaluate the prognostic implications of the treatment strategies implemented.</p> <p><strong>Methods: </strong>In a single university hospital centre with cardiac surgery on site, consecutive patients, from Jan 2015 to Dec 2016, with a formal indication for heart valve surgery referred for a pre-op routine coronary angiogram were systematically analysed. Baseline characteristics, valve pathology and CAD prevalence and patterns were determined. Obstructive CAD was defined as luminal angiographic stenosis ≥70%. The prognostic impact of the different valve disease and CAD treatment strategies were ascertained.</p> <p><strong>Results</strong>: 613 patients (mean age 73.5±10,1; male 48.9%) fulfilled the clinical or echocardiographic indication for valve surgery by European guidelines. 83.3% presented arterial hypertension, 67.4% dyslipidemia, 25.4% Diabetes Mellitus (DM), 7% previous stroke and 10.4% chronic kidney disease (CKD). Valvulopathy prevalence was: aortic stenosis (66.4%), aortic regurgitation (7.2%), mitral stenosis (4.6%), mitral regurgitation (21.5%)a and tricuspid regurgitation (10.4%). Obstructive CAD was present in 22.3% of patients. Of those surgical revascularization was proposed in 81.4% and conducted in 51.3%. The revascularization strategy conducted was different from the one planned in 47.6% of patients with obstructive CAD. Follow-up time was 40.5±18.4 months. All-cause mortality rate during follow up was 14.2%, with 9.3% from cardiovascular causes. In univariate analysis DM, previous stroke, CKD, NYHA, left main disease, refused for surgery and also conducting a revascularization strategy different from the one prevue were associated with higher all-cause mortality rate (p<0.05). In the multivariate analysis only the presenting NYHA persisted as an independent all-cause mortality predictor (OR 14.1, 95% CI 1.5-132.1, p=0.021). </p> <p><strong>Conclusion</strong>: In a contemporary cohort of valvular heart disease patients CAD prevalence is lower than described in previous studies. Obstructive CAD was present in 22.3% of screened patients and surgical revascularization was obtained in less than half of these. Mortality rates were higher in patients presenting comorbidities, left main disease, worse NYHA functional class and in those refused for surgery or in whom performed revascularization was different from planned.</p>
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