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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
37. Miscellanea
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Resting heart rate, exercise capacity and outcomes in heart failure patients: A comparison of atrial fibrillation and sinus rhythm
Session:
CO5 - Insuficiência Cardíaca
Speaker:
Rita Loreto Ilhão Moreira
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:
Rita Ilhão Moreira; Tiago Pereira Da Silva; António Valentim Gonçalves; Madalena Coutinho Cruz; Tiago Mendoça; Tânia Branco Mano; Pedro Garcia Brás; Alexandra Castelo; Joana Gomes Feliciano; Rui M. Soares; Rui Cruz Ferreira
Abstract
<p><strong>Background: </strong>Higher resting heart rate (HR) is associated with lower exercise capacity and worse prognosis in patients (pts) with heart failure (HF). However, recent studies question this relationship in HF pts in atrial fibrillation (AF).</p> <p><strong>Aim: </strong>To examine and compare the relationships between resting HR, exercise capacity and outcomes in HF pts in AF and sinus rhythm (SR).</p> <p><strong>Methods: </strong>Ambulatory pts with symptomatic HF 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. Pts were divided according to rhythm status into SR and AF group. All pts 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 282 pts enrolled (75% male, 54±12 years, LVEF 27±7%), 19.1% had AF. As compared with pts in SR, AF pts were older (p 0.002), more predominantly men (p 0,029), had higher BNP levels (p 0.027) and lower Heart Failure Survival Score (p 0.001). There were no differences regarding maximal effort (respiratory exchange ratio), but AF group had lower peak oxygen consumption (VO2) (p 0.001) and higher ventilation equivalent of carbon dioxide (VE/VCO2) slope (p 0.002). Percentage of predicted pVO2 was a strong predictor of adverse outcomes in both SR and AF pts (AUC 0.798, p <0.001 and AUC 0.834, p <0.001, respectively). In the SR group, there was an inverse relationship between resting HR and exercise capacity (fig. 1A). In the AF group, this relationship was reversed as higher resting HR was associated with better exercise tolerance (fig. 1B). Regarding outcomes, the composite endpoint occurred in 24.4% during follow-up. Pts in SR with a resting HR higher than 72 bpm had higher risk of composite outcome than those with lower resting HR (fig. 1C). In AF pts, resting HR demonstrated an opposite effect for the composite endpoint though it did not achieve statistical significance (fig. 1D).</p> <p><strong>Conclusion: </strong>The impact of resting HR on exercise capacity and prognosis differed entirely between AF and SR, suggesting that HR control may need to be managed differently for AF and SR in HF pts.</p>
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