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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)
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E/E´ ratio, a predictor of in-hospital complications in acute myocardial infarction
Session:
Posters 1 - Écran 1 - Doença Coronária
Speaker:
João Miguel Santos
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
João Miguel Santos; Inês Pires; Luísa Gonçalves; Hugo Da Silva Antunes; Júlio Gil; Luís Abreu; Inês Almeida; Emanuel Correia; José Costa Cabral
Abstract
<p><strong>Introduction</strong></p> <p>Diastolic dysfunction is an early finding in patients presenting with acute myocardial infarction (AMI), often heralded by an increase in E/E’ ratio. The purpose of this study was to assess the relationship between the E/E’ ratio and in-hospital complications (IHC) in AMI.</p> <p> </p> <p><strong>Methods</strong></p> <p>A retrospective analysis of 250 patients admitted to a Cardiology ward diagnosed with AMI was performed. The primary endpoint was defined as the composite of re-infarction, stroke, mechanical complications (MC), heart failure (HF), acute kidney injury (AKI) and/or arrythmia. Mann-Whitney U test was used for mean comparison between variables. Two different multivariable logistic regression (MRlog) models were applied, one evaluating the effect of other echocardiographic variables besides E/E’ ratio (left ventricular ejection fraction – LVEF, pulmonary artery systolic pressure – PASP, telediastolic diameter of left ventricle and left atria diameter) and the other one evaluating the effect of clinical variables (age, obesity, history of hypertension and diabetes mellitus) on IHC. A Pearson analysis was performed to evaluate correlation between variables.</p> <p> </p> <p><strong>Results</strong></p> <p>IHC occurred in 158 patients (63%). 73% of patients in the population were male, and the mean age was 69 (±13) years. HF occurred in 51% of patients, arrythmias in 22%, AKI in 11% and MC in 1%. No re-infarction/stroke was noticed. Mann-Whitney U test revealed a statistically significant association between E/E’ ratio and IHC (p<0.001). The MRlog using the echocardiographic variables above mentioned demonstrated a statistically significant result for E/E’ ratio (p=0.016 – Exp(B): 0.847) and for PASP (p=0.009 – Exp(B): 0.906). The MRlog model that included clinical variables demonstrated that E/E’ ratio retained predictive value for IHC (p=0.022 – Exp(B): 0.922). For each unit increase in E/E’ ratio, the probability of not having an IHC decreases by 8-15%, according to the model used. The effect of E/E’ ratio on IHC was mainly driven by the risk of developing HF (p=0.03, Exp(B):0.88). Pearson correlation test between variables did not achieve statistical significance, therefore an independent variation between them was admitted.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>The increase in E/E’ ratio is associated with a higher risk of IHC. E/E’ ratio has predictive value in IHC risk, particularly HF, which is independent from the effect of other clinical and echocardiographic variables. </p>
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