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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
P. Other
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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Paradoxo dos Factores de Risco Cardiovasculares no prognóstico a longo prazo de Síndromes Coronárias Agudas
Session:
Posters 3 - Écran 03 - Isquemia/SCA
Speaker:
Rita Loreto Ilhão Moreira
Congress:
CPC 2018
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Rita Ilhão Moreira; Tiago Pereira Da Silva; António Valentim Gonçalves; João Pedro Reis; Tânia Branco Mano; Tiago Mendonça; Madalena Coutinho Cruz; Luís Almeida Morais; Dra. Inês Rodrigues; Pedro Modas Daniel; Pedro Rio; Joana Gomes Feliciano; Ana Abreu; Rui M. Soares; Rui Cruz Ferreira
Abstract
<p><strong>Aims: </strong>High body mass index (BMI) is associated with improved outcomes in heart failure with reduced ejection fraction, a finding leading to the concept of an obesity paradox. We aim at investigating the impact of exercise tolerance and cardiorespiratory capacity on the obesity paradox.</p> <p><strong>Methods</strong><strong>:</strong> Ambulatory patients with symptomatic heart failure and left ventricular ejection fraction ≤40%, followed in our center, prospectively underwent a baseline comprehensive evaluation including clinical, laboratorial, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. Peak VO2 (pVO2) was normalized for body mass and in obese patients adjusted to lean body mass. The study population was divided according to BMI (<25, 25–30, >30 kg/m<sup>2</sup>). A sub-analysis of patients of the BMI <25 kg/m<sup>2</sup> group, differentiating BMI <20 and 20-25 kg/m<sup>2</sup> was also performed. All patients were followed for 60 months and the combined endpoint was defined as cardiac death, urgent heart transplantation or need for mechanical circulatory support.</p> <p><strong>Results:</strong> In the 263 enrolled patients (75% male, 54 ±12 years, LVEF 28±7%, BMI 27±4 kg/m<sup>2</sup>), 74 events occurred. Patients with higher BMI had better LVEF (p 0.003), percentage of predicted pVO2 (p<0.001), ventilation equivalent of carbon dioxide (VE/VCO2) slope (p 0.006), serum sodium concentration (p 0.021) and Heart Failure Survival Score (p 0.046) compared with the lower BMI groups. At univariable analysis, both BMI, pVO2 and VE/VCO2 slope were significant predictors of outcome (HR 0.940, 95% CI 0.886-0.998, p 0.042; HR 0.791, 95% CI 0.742-0.842, p <0.001 and HR 1.164, 95% CI 1.135-1.194, p<0.001, respectively). In the sub-analysis of patients with BMI < 25 kg/m<sup>2</sup>, very low BMI was associated with worse outcomes (log-rank p 0.014). At multivariable Cox regression analysis adjusting for pVO2 or for VE/VCO2 slope, the protective role of BMI disappeared (p 0.101 and p 0.786, respectively).</p> <p><strong>Conclusion:</strong> These results suggest that exercise tolerance affects the relationship between BMI and survival. Thus, cardiorespiratory fitness may mitigate the obesity paradox in heart failure patients.</p>
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