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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
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
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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26. Cardiovascular Surgery
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30. Cardiovascular Disease in Special Populations
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32. Cardiovascular Nursing
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Prognostic power of cardiopulmonary exercise test in transposition of the great arteries patients
Session:
Posters 1 - Écran 5 - Congénitos
Speaker:
António Valentim Gonçalves
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.6 Congenital Heart Disease – Clinical
Session Type:
Posters
FP Number:
---
Authors:
António Valentim Gonçalves; Tânia Branco Mano; Sílvia Aguiar Rosa; Ana Figueiredo Agapito; Lidia De Sousa; José Alberto Oliveira; André Viveiros Monteiro; Pedro Rio; Tiago Mendonça; João Pedro Reis; Pedro Modas Daniel; Pedro Garcia Brás; Vera Ferreira; Alexandra Castelo; Rui Cruz Ferreira
Abstract
<p><strong>Background</strong></p> <p>Both transposition of the great arteries (TGA) previously submitted to a Senning or Mustard procedure and congenitally corrected TGA (cc-TGA) have the systemic circulation supported by the morphological right ventricle, thereby rendering these patients to a risk for Heart Failure (HF) events. Whether this risk can be stratified by cardiopulmonary exercise test (CPET) is not established.</p> <p>The aim of this study was to compare different CPET parameters for stratifying the risk of TGA patients.</p> <p> </p> <p><strong>Methods</strong></p> <p>Retrospective evaluation of adult TGA patients with systemic circulation supported by the morphological right ventricle submitted to CPET in a tertiary centre who were followed for at least one year for the primary endpoint of death from any cause or HF hospitalization. Several CPET parameters were analysed as potential predictors of the combined endpoint (Cox analysis) and their predictive power was compared (area under the curve (AUC) analysis).</p> <p> </p> <p><strong>Results</strong></p> <p>CPET was performed in 43 TGA patients (36 patients with atrial-switch TGA correction and 7 patients with cc-TGA), with a mean age of 35.0 ± 8.6 years and 31 males (72.1%). There were 8 (18.6%) cyanotic patients. Pacemaker implantation was previously performed in 8 patients (18.6%), with only 1 patient not on sinus rhythm during CPET (atrial fibrillation rhythm). </p> <p>There were 10 (23.3%) patients reaching the primary endpoint in the follow-up (3.2 ± 2.4 years). Table 1 represents the AUC and Cox analysis of each parameter. Optimal point of ventilation and end-tidal CO<sub>2</sub> at anaerobic threshold (AT) were the only CPET parameters who did not achieve a significant risk prediction.</p> <p>Heart rate in anaerobic AT had the highest AUC value (0.864), followed by peak oxygen consumption (pVO<sub>2</sub>) (0.852). A heart rate at AT ≤ 94bpm had a sensitivity of 87.5% and a specificity of 84.5% for the primary outcome, while a pVO<sub>2 </sub>≤ 20ml/kg/min had a sensitivity of 80.0% and a specificity of 78.8% for the primary outcome.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>CPET can be used to stratify which TGA patients with systemic circulation supported by the morphological right ventricle are in higher risk for HF events, with a heart rate at AT ≤ 94bpm with the highest predictive power of all parameters analysed.</p>
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