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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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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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32. Cardiovascular Nursing
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Predictors of significant coronary artery disease in exercise echocardiography
Session:
Posters 3 - Écran 07 - Ecocardiografia
Speaker:
Maria Trêpa
Congress:
CPC 2018
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Maria Trêpa; Raquel Baggen Santos; Marta Fontes Oliveira; Inês Silveira; Mário Silva Santos; Filomena Oliveira; Sousa Pereira; Sofia Cabral; Vasco Alves Dias; Severo Torres
Abstract
<p>Introduction</p> <p>Exercise echocardiography (ExEcho) is a useful and widely used tool in patients with suspected coronary artery disease (CAD). It yields functional capacity, electrocardiographic and ultrasound data. Few studies have addressed its performance in predicting the presence of significant CAD (SigCAD).</p> <p> We aimed to study the ExEcho predictors of SigCAD.</p> <p>Methods</p> <p>We included patients who had an ExEcho and then had undergone invasive coronary angiography. SigCAD was defined as >50% stenosis in left main or > 70% stenosis in ≥ 1 arteries requiring intervention. Patients’ baseline characteristics and ExEcho parameters were analyzed. We used logistic regression and ROC curves to assess independent predictors and their discriminative capacity. </p> <p>Results</p> <p>Of the 125 patients studied, 65% (n=81) had SigCAD. Patients with SigCAD were older (63 vs 67yo, p=0.022), more likely males (59% vs 88%, p< 0.001), and smokers (50% vs 78%, p=0.037). Typical chest pain did not predict SigCAD (64% vs 65%, p=0.89), neither did complete left bundle branch block (p=0.65) or atrial fibrillation (p=0.67). </p> <p>Regarding to ExEcho parameters, the presence of SigCAD was associated to a positive EKG stress test (53% vs 75%, p=0.012), a bigger change in wall motion score index ( 0.2 vs 0.5, p=0.009), lower functional capacity (assessed by predicted metabolic equivalents, mean 8.7 vs 8, p=0.022), having a positive ExEcho in the left descending artery (LAD) territory (42% vs 78%, p<0.001) or in the circumflex artery territory ( 53% vs 75%, p=0.009). </p> <p>A positive ExEcho in the right coronary artery territory (p=0.77) or a positive EKG test only in leads DII, DIII and aVF (p=0.72) were not associated with SigCAD.</p> <p>In the multivariate regression model, the lower functional capacity (OR 0.97, p=0.003), a positive ExEcho in LAD territory (OR 5.2, p=0.002) and a positive EKG stress test (OR 3.2, p=0.01) were independent predictors of SigCAD. The combination of these 3 parameters had an excellent diagnostic accuracy (area under ROC curve: 0.8).</p> <p>Conclusion</p> <p>A lower functional capacity, a positive ExEcho in LAD territory and a positive EKG stress test were independently associated to SigCAD. When used together they had a good discriminative capacity. In contrast, abnormal ST-segment changes restricted to leads DII, DIII and aVF and abnormal wall motion in right coronary artery territory were not useful to predict with SigCAD.</p>
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