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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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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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30. Cardiovascular Disease in Special Populations
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32. Cardiovascular Nursing
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Intraventricular gradient in exercise echocardiogram: a single-center experience
Session:
Posters 3 - Écran 9 - Imagiologia Cardiovascular
Speaker:
Rita Ventura Gomes
Congress:
CPC 2019
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
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Session Type:
Posters
FP Number:
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Authors:
Rita Ventura Gomes; Antonio; Ana Rita F. Pereira; Daniel Sebaiti; Ana I. Marques; Dra. Inês Cruz; Ana Almeida; Paula Fazendas; Isabel João; Carlos Cotrim; Helder Pereira
Abstract
<p><strong>Introduction</strong></p> <p>The development of intraventricular gradient (IVG) during exercise is rare and usually associated with left ventricular hypertrophy (LVH). Exercise echocardiography (EE) is a fundamental tool for its assessment and to establish a relation between the patients’ complaints and the hemodynamic changes during exercise.</p> <p><strong>Purpose</strong></p> <p>To evaluate the baseline characteristics, therapeutic strategies and the long-term outcomes of patients (pts) with IVG during EE.</p> <p><strong>Methods</strong></p> <p>Retrospective cohort study of pts with a significant IVG (> 50mmHg) during EE, and no more than moderate valvular heart disease, who were examined in our echo lab between January 2011 and December 2017. Mean follow-up (FU) duration was 5,2±1,9 years.</p> <p><strong>Results</strong></p> <p>A total of 146 pts were included in the analysis (mean age 46,0±19,2years; 74,0% male).</p> <p>The main indication for performing the EE was to further investigate pts’ complaints (chest discomfort (15,8%), fatigue (9,6%), dizziness (2,7%)). 54 (37,0%) were on beta-blockers (BB) or nondihydropyridine calcium channel blockers (CCB) at the time of the EE.</p> <p>The main pathological echocardiographic findings were hypertrophic myocardiopathy (26,0%, n=38) and LVH (40,7%, n=57). 43 pts (30,7%) had a normal echo.</p> <p>The mean immediate recovery period IVG was 99,1±44,7mmHg. 47pts (32,2%) developed systolic anterior motion of the mitral valve, 25 (17,1%) had a hypotensive response to exercise (8pts symptomatic) and 6 (4,1%) had ST segment depression. There were no differences between pts on BB/CCB and those with no drugs during EE.</p> <p>After the exam, 61pts (41,8%) started therapy with or changed the dosage of BB/CCB. The remaining were advised to perform non-pharmacological measures.</p> <p>22pts reported resolution of the initial symptoms. Only 45pts (30,8%) performed a second EE and 33 (71,1%) had a reduction in IVG. A significant higher number of pts on pharmacological therapy had a resolution of the initial symptoms (31,1%vs3,5%, p=0,002) and a reduction in IVG (88,5%vs47,4%, p=0,003).</p> <p>During the 5 years of FU, 3pts died and 3 had at least one hospitalization.</p> <p><strong>Conclusion</strong></p> <p>A significant IVG during EE can help the cardiologist to clarify undefined symptoms and to tailor treatment options. Even though, IVG is frequently associated with structural cardiac changes, in this study there was a significant number of pts with a normal rest exam. Treatment with BB improved symptoms and reduced IVG.</p> <p>In a 5-year FU, the adverse events in pts with IVG are rare.</p>
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