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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
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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
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Prognostic of cardiopulmonary exercise test in heart failure patients with atrial fibrillation
Session:
CO5 - Insuficiência Cardíaca
Speaker:
António Valentim Gonçalves
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
António Valentim Gonçalves; Tiago Pereira Da Silva; Rui M. Soares; Rita Ilhão Moreira; Joana Gomes Feliciano; Pedro Rio; Ana Abreu; João Pedro Reis; Tiago Mendonça; Tânia Branco Mano; Madalena Coutinho Cruz; Pedro Garcia Brás; Alexandra Castelo; Vera Ferreira; Rui Cruz Ferreira
Abstract
<p><strong>Introduction</strong></p> <p>Atrial fibrillation (AF) is associated with increasing mortality in Heart Failure (HF) patients. Whether AF patients can be precisely stratified by cardiopulmonary exercise test (CPET) cut-offs for Heart Transplantation (HT) selection is not established.</p> <p>The aim of the study was to compare the prognostic importance of CPET parameters in HF patients with AF versus sinus rhythm (SR).</p> <p><strong>Methods</strong></p> <p>The study was a prospective evaluation of 274 consecutive HF patients with left ventricular ejection fraction ≤40%. The primary endpoint was a composite of cardiac death or urgent HT in the first year of follow-up. Secondary endpoints included all-cause mortality, sudden cardiac death and death for worsening HF. For the purpose of selecting patients who would benefit from early selection for HT, the guideline recommended cut-off value of peak VO2 (≤ 12 ml/kg/min) and VE/VCO2 slope (> 35) for HT selection were compared for positive and negative predictive value (PPV and NPV, respectively) of the primary endpoint in AF and sinus rhythm (SR) patients.</p> <p>Patients with elective HT during the follow-up period were excluded from the analysis.</p> <p><strong>Results</strong></p> <p>There were 51 patients in the AF group and 223 in the SR group. Primary outcome was more frequent in the AF group (17.6% VS 8.1%, p 0.038), as well as all-cause mortality (17.6% VS 6.3%, p 0.008) and sudden cardiac death (7.8% VS 2.2%, p 0.043). Table 1 represents the area under the curve of each parameter analysed.</p> <p>The cut-off value of peak VO2 for HT selection showed a PPV of 100% and an NPV of 95.5% for the primary outcome in the AF group, while the cut-off value for VE/VCO2 slope showed lower values of PPV (33.3%) and similar NPV (92.3%).</p> <p><strong>Conclusion</strong></p> <p>Despite the fact that AF carries a worse prognosis for heart failure patients, a peak VO2 ≤ 12 ml/kg/min can precisely stratify this high-risk group with a higher PPV than VE/VCO2 slope.</p>
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