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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
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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
37. Miscellanea
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Respiratory disturbance index estimated by antibradycardia pacemaker is a predictor of acute decompensated heart failure at 1-year follow-up: a prospective observational study
Session:
Posters 3 - Écran 06 - IC - Prognóstico
Speaker:
João Bicho Augusto
Congress:
CPC 2018
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
João Bicho Augusto; João Baltazar Ferreira; Susana Antunes; Mariana Faustino; Nuno Cabanelas; Ana Ferreira; Hugo Vasconcelos; Francisco Madeira; Carlos Sequeira De Morais
Abstract
<p><strong>Background</strong>: Sleep apnea (SA) is highly prevalent in pacemaker (PM) patients and it is associated with increased risk of heart failure. Currently, several conventional antibradycardia pacemakers incorporate a SA monitoring (SAM) function, which enables the detection of severe SA.</p> <p><strong>Purpose</strong>: We aimed to assess the impact of respiratory disturbances during night on adverse clinical outcomes at 1-year follow-up in patients with PM.</p> <p><strong>Methods</strong>: We conducted a prospective study on 37 consecutive patients evaluated in a PM clinic who had a single or dual-chamber PM with incorporated SAM. SAM detects and reports abnormal breathing events during night, which can be measured as number of apnea-hypopneas (AH) per hour: the respiratory disturbance index (RDI). We have previously shown that high RDI during night correlated with high morning pulmonary capillary wedge pressures and high proBNP values. Prior to follow-up, we measured night RDI trends during a course of 6 months as the % of time during night with RDI >20 AH/h (cut-off for severe sleep apnea according to the DREAM study). Primary outcome was defined as admission for acute/decompensated heart failure (ADHF). Secondary outcomes included non-cardiovascular death, incidence of new onset atrial fibrillation and a composite of cardiovascular death, stroke and ADHF.</p> <p><strong>Results</strong>: Follow-up was possible for all patients. Mean age at follow-up was 80.3 ± 11.2 years, 45.9% male. Median % of RDI >20 AH/h in the 6 months prior to follow-up was 11% (interquartile range 1 - 27AH/h). At 1-year follow-up there were 3 admissions for ADHF, 1 admission following stroke, 6 admissions for other reasons, 3 cardiovascular deaths and 1 non-cardiovascular death. Receiver operating characteristics curve analysis showed that higher baseline % of time with RDI >20AH/h was associated with admission for ADHF (AUC 0.863, CI 95 0.731-0.995, p=0.040). Using an optimal cut-off of 25% of time with RDI >20AH/h, we found a sensitivity of 99.9% and a specificity of 76.5% for ADHF at 1-year follow-up. Figure 1 shows Kaplan-Meyer curves of survival according to % of RDI >20AH/h. Percentage of time with RDI >20 AH/h was not a significant predictor of composite secondary outcome (p=0.266), nor non-cardiovascular death (p=757) or new onset atrial fibrillation (p=0.164).</p> <p><strong>Conclusions</strong>: Patients with respiratory disturbances lasting for at least a quarter of the night are at high risk of admission for ADHF at 1-year follow-up. RDI might be a useful tool in the risk stratification of heart failure.</p>
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