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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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Pharmacologic stress test: still an important prognostic factor? A follow-up study
Session:
Posters 2 - Écran 8 - Doença Coronária
Speaker:
Vera Vaz Ferreira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Vera Ferreira; Luisa Moura Branco; Ana Galrinho; Pedro Rio; Sílvia Aguiar Rosa; Fernanda Varela Gameiro; Duarte Cacela; Alexandra Castelo; Pedro Garcia Brás; Tânia Branco Mano; João Pedro Reis; Rui Cruz Ferreira
Abstract
<p><strong>Introduction:</strong> Dobutamine stress echocardiography (DSE) is an established technique for evaluation of extent and severity of coronary artery disease.</p> <p><strong>Purpose:</strong> To analyse the results and complications of DSE and identify prognostic predictors in patients (P) who underwent DSE for myocardial ischemia detection.</p> <p><strong>Population and methods:</strong> 220P who underwent consecutive DSE from 2013 to 2017. P with significant valvular disease were excluded. Clinical data, echocardiographic parameters and data from follow up regarding all-cause mortality and MACEs, consisting of all-cause mortality, acute myocardial infarction (MI), hospital admissions for decompensated heart failure (HF), unstable angina or new arrhythmias were registered. The mean age of our cohort was 64.8±12.0 years, with 143 men (65%).</p> <p><strong>Results:</strong> 88P (40%) had positive, 102 (46.4%) had negative and 30 (13.6%) had inconclusive DSE; complications rate of 15%. The prevalence of hypertension, diabetes mellitus (DM) and dyslipidemia was 82.7%, 42.3% and 67.7%, respectively. 35.9% had history of a prior myocardial infarction, 31.8% of percutaneous coronary intervention (PCI), 10.9% of coronary artery bypass graft (CABG) and 9.5% had heart failure (HF). Mean left ventricular end-systolic (LVSD) and end-diastolic dimensions were 33.7±8.9 and 52.8±7.1mm. In DSE, there were resting wall motions abnormalities in 90 P (40.9%). Mean resting wall motion score index (rWMSI) and peak (pWMSI) were 1.16±0.28 and 1.24±0.34. Mean resting GLS (rGLS) and peak GLS (pGLS) were -16.3±4.3 and -16.6±4.3. Mean number of ischemic segments was 1.7±2.4 and 16.8% P had ischemia of more than 3 segments. There was ischemia in left anterior descending (LAD) coronary in 53P and in circumflex and right coronary territories in 18 and 68P. 22.6% had more than one ischemic territory. 43P (49.4%) underwent intervention, 38 with PCI and 5 with CABG. During a mean FU of 38.8±16.8 months, 47 MACEs were observed, including 32 deaths (14.5%). Positive DSE (p=0.012), no. of ischemic segments (p=0.019), ischemia in the LAD p=0.003), rGLS (p=0.038) and pGLS (p=0.038) were related to the occurrence of MACEs. In Cox regression analysis, age (p=0.005), DM (p=0.005), HF (p=0.006), prior CABG (p=0.015), LVSD (p=0.026), rWMSI (p=0.029), pWMSI (p=0.013) and pGLS (p=0.038) were associated with increased all-cause mortality. Kaplan–Meier survival analysis showed that survival was significantly worse for ischemia of more than 3 segments (log rank 0.005), ischemia of more than one territory (log rank 0.025) and pWMSI >1.5 (log rank<0.0005). With multivariate Cox regression analysis, age >65Y (HR 4.22, p=0.004), DM (HR 2.49, p=0.038) and pWMSI>1.5 (HR 9.73, p=0.007) were independently associated with all-cause mortality.</p> <p><strong>Conclusion:</strong> In patients who underwent DSE there were some baseline and DSE-related independent predictors of long term prognosis: age, DM and peak WMSI.</p> <p> </p>
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