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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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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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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
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29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Hypertrophic cardiomyopathy and hypertensive cardiopathy - One or the other or both, that Is the question
Session:
Posters 1 - Écran 4 - Doenças do Miocárdio
Speaker:
José Pedro Sousa
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.1 Myocardial Disease – Pathophysiology and Mechanisms
Session Type:
Posters
FP Number:
---
Authors:
José Pedro Sousa; Luís Puga; Joana M. Ribeiro; Liliana Reis; Carolina Négrier; Lino Gonçalves
Abstract
<p><strong>Introduction: </strong>Hypertension (HTN) is highly prevalent in general population, and patients with hypertrophic cardiomyopathy (HCM) are no exception. However, in this setting, coexisting HTN introduces diagnostic and therapeutic dilemmas. Moreover, the natural history of this disease combination is yet to be comprehensively described.</p> <p> </p> <p><strong>Aim: </strong>To typify the subgroup of HCM patients who also suffer from HTN.</p> <p> </p> <p><strong>Methods: </strong>Retrospective single-center study comprising patients regularly attending cardiology consultation for HCM. Meeting HCM diagnostic definition as described in European Society of Cardiology (ESC) 2014 specific guidelines was deemed mandatory for study inclusion. Demographic, familial, genetic, clinical, electrocardiographic, imaging, therapeutic and prognostic data were assessed. Follow-up, by means of electronic health record checking and telephone calling, was performed targeting all-cause mortality and non-fatal but clinically significant ventricular arrhythmias.</p> <p> </p> <p><strong>Results: </strong>115 patients were included between May 2008 and September 2016. Median age was 65 (53-74) years and 54.5% were female. 40.5% had a positive genetic test, 52.6% had obstructive HCM, 34.9% had a typical pattern of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) and 21.4% were managed with cardioverter-defibrillator implantation (ICD). Median follow-up was 16 (2-103) months, with mortality occurring in 9% and non-fatal but clinically significant ventricular arrhythmias in 21.9%. 69.6% had comorbid HTN. Hypertensive HCM patients were older (p <0.001) and exhibited less positive genetic testing (ZRES -2.7, p 0.011) and higher risk of mitral regurgitation (ZRES 3, p 0.004), systolic anterior motion of the mitral valve (ZRES 2.8, p 0.01) and atrial fibrillation (ZRES 2.1, p 0.047), as well as a greater left atrium volume, as assessed by both echocardiography and MRI (p 0.009). Conversely, presence of family history of sudden cardiac death (SCD), syncope, heart failure, EKG left ventricular hypertrophy criteria, conduction disease, LV outflow tract obstruction, right ventricular hypertrophy, LGE and ICD did not differ significantly. The same applies to diastolic dysfunction severity, median IVS thickness, as well as to ESC HCM Risk-SCD score and death and ventricular arrhythmia risk.</p> <p> </p> <p><strong>Conclusion: </strong>In addition to age, genetic testing appears to be the most valuable resource for avoiding misdiagnosis between HCM and hypertensive cardiopathy, thus proving HCM classic pure structural/loading diagnostic definition to be inappropriate in this setting. In spite of displaying a higher burden of mitral regurgitation and atrial fibrillation, prognosis of the hypertensive subset of HCM patients remains predominantly driven by the primary myocardial disease.</p>
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