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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
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
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Abstract
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CLEAR FILTERS
The prognostic impact of hepatic injury in acute heart failure
Session:
Posters 3 - Écran 7 - Insuficiência Cardíaca
Speaker:
Lisa Maria Ferraz
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Lisa Maria Ferraz; José Luís Costa Martins; Pedro Teixeira Carvalho; Ana Catarina Faustino; José António Santos
Abstract
<p>Introduction: Hepatic injury has been reported in patients with acute heart failure (AHF).</p> <p>Purpose: This study aims to assess the prognostic value of elevated transaminases (TM) and alkaline phosphatase (AP) in patients (P) admitted for AHF.</p> <p>Methods: Retrospective study of 618 consecutive P admitted in our Hospital for AHF: 57% women, 79±11 years, 61% hypertensive, 23% with chronic kidney disease, 16% with coronary artery disease. A comparative analysis was performed according to the elevation above 2x the upper normal limit of aspartate or alanine TM (TM+: with vs TM0: without) and of AP (AP+: with vs AP0: without), regarding demographic, clinical and analytical parameters, and medication during hospitalization, to evaluate potencial predictors. Prognosis (mortality) was assessed by Cox Regression during a 6 month follow-up. </p> <p>Results: AP elevation occurred in 14.8% P. By univariate analysis, the group AP+ had higher basal values of urea (63.6 vs 54.9mg/dL, p=0.02) and creatinine (1.24 vs 1.08mg/dL, p=0.02), and required higher doses of furosemide during hospitalization (387 vs 316.2mg, p=0.04). By multivariable regression, only basal creatinine was independent predictor of AP+ (OR 0.137, 95%CI 0.001–0.253, p=0.048). TM elevation occurred in 22.5% P. By univariate analysis, P with TM+ were younger (78±11 vs 80±10 years, p=0.02), showed higher values of AP (157.2 vs 128U/L, p=0.001) and hemoglobin (12.7 vs 12.2g/dL, p=0.02), with no difference in furosemide dose (p=ns). By multivariable regression, AP was an independent predictor of TM+ (OR 0.173, 95%CI 0.000–0.002, p=0.01). No differences were found regarding blood pressure, ejection fraction, NT-proBNP value or lenght of stay for both AP+ and TM+ groups. Mortality was 21% at 30 days and 38% at 6M. Survival was worse at 30 days for AP+, after adjustment for demographics and comorbidities (HR 0.4, 95CI%: 0.25–0.74, p=0.002). Regarding TM elevation, no survival difference was found; however, in TM+ group, hemoconcentration occurred in 41.2% of P and was associated with increased survival at 6M (HR 49.8; 95%CI 2.44–1016.72; p=0.011), as well as the use of higher doses of furosemide (HR 1.0; 95%CI 1.001–1.005; p=0.012).</p> <p>Conclusion: Elevation of AP was associated with higher mortality in P admitted for AHF. TM elevation alone didn´t show prognostic impact; nevertheless, its association with hemoconcentration and higher furosemide doses seems to improve survival.</p>
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