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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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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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23. Peripheral Vascular and Cerebrovascular Disease
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Frequency and predictors of mortality in arrhythmia-induced cardiomyopathy: a diagnosis not to be missed
Session:
Posters 5 - Écran 5 - Insuficiência Cardíaca
Speaker:
Sofia Alegria
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.1 Acute Heart Failure – Pathophysiology and Mechanisms
Session Type:
Posters
FP Number:
---
Authors:
Sofia Alegria; Ana I. Marques; Ana Rita F. Pereira; Alexandra Briosa; Daniel Sebaiti; Ana Almeida; Rita Miranda; Sofia Almeida; Luis Brandão; Otilia Ferreira Simões ; Helder Pereira
Abstract
<p><strong>Background: </strong>Arrhythmia-induced cardiomyopathy (AIC) is characterized by left ventricular (LV) systolic dysfunction caused by arrhythmia which is reversible once the arrhythmia is properly controlled. There is scarce scientific evidence regarding the clinical features and therapeutic implications of this condition.</p> <p><strong>Purpose: </strong>To characterize the population of patients with suspected AIC and to determine predictors of recovery of LV systolic function and of all-cause mortality.</p> <p><strong>Methods: </strong>Retrospective analysis of patients admitted in a Cardiology department with a probable diagnosis of AIC between 2012 and June 2018. Logistic and Cox regression analyses were used to determine predictors of recovery of LV systolic function (improvement of LV ejection fraction – EF of ≥10%) and of mortality, respectively.</p> <p><strong>Results: </strong>Fifty-eight patients were included, with a mean age of 62±10 years, and male predominance (66%). The most common associated arrhythmia was AF (50%), followed by atrial flutter (AFL – 26%), both AF and AFL (19%) and other tachyarrhythmias (5%). The mean body mass index was 29±5kg/m<sup>2</sup>, the prevalence of arterial hypertension was 56.9%, cerebrovascular disease 13% and hypothyroidism 9%. On admission most patients were on functional class III or IV (61 and 23%, respectively), the median NT-proBNP was 2511 pg/ml, the mean LV EF was 28±10%, 54% had a dilated LV, 87% a dilated left atrium and 68% right ventricular systolic dysfunction.</p> <p>During follow-up (median 637 days), 84% of patients converted to sinus rhythm (SR); 50% were submitted to electric cardioversion, 17% to pharmacological conversion and 41% to catheter ablation (success rate of 88%). Among patients who converted to SR, 52% had recurrence of AF or AFL during follow-up.</p> <p>On reassessment (median 257 days after admission) 60% of the patients were in SR, and the heart rate (HR) was controlled in 93% (median HR 70 bpm). There was an improvement in functional class (4% in class III and none in class IV), NT-proBNP (median 639 pg/ml), and LV systolic function (88% had recovery and 60% normalization of systolic function – mean LV EF 51±10%).</p> <p>Recovery of LV function was associated with both SR and controlled HR in reassessment. On multivariate logistic regression analysis, the predictors of recovery of LV function were the presence of hypothyroidism and the mean HR on reassessment, with an increase in HR by 1 bpm associated with a reduction of 9% in the likelihood of recovery.</p> <p>During follow-up 17% of patients died and the independent predictors of all-cause mortality were an history of cerebrovascular disease and absence of recovery of LV function.</p> <p><strong>Conclusions: </strong>In our population AIC was more commonly associated with AF, and patients usually presented with severe symptoms and LV systolic dysfunction. Both maintaining SR and controlling the HR are important for the recovery of LV systolic function, which was a predictor of survival in this population.</p>
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