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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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0 Topics
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
36. Basic Science
37. Miscellanea
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Cardiac damage in severe aortic stenosis - valve intervention can still save the day
Session:
Posters 5 - Écran 8 - Doença Valvular
Speaker:
Mariana Saraiva
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Mariana Saraiva; M. João Vieira; Ana Rita Moura; Nuno Craveiro; Kevin Domingues; Maria Da Luz Pitta; Margarida Leal
Abstract
<p>Introduction: Severe aortic stenosis (SAS) encloses an adverse prognosis when a conservative approach is chosen. Main indications for valve intervention (VI) (either percutaneous or surgical) include the presence of symptoms or a reduction in left ventricular ejection fraction (LVEF). However, even after VI, some patients (pts) ­are left with the burden of heart failure (HF), without major improvement of prognosis: probably, these pts are left with a relevant extent of "cardiac damage", as suggested by Génereux et al.. Pts with pulmonary hypertension (PH) usually have the worst prognosis, putting the benefits of VI into question in this population.<br /> Purpose: evaluate the prognosis of pts with SAS and PH and the potential benefits of VI.<br /> Methods: retrospective study of a population with severe aortic stenosis, divided in 2 groups: group A - under conservative treatment (either due to patient refusal of VI, Heart Team refusal for VI or asymptomatic and normal LVEF); group B - underwent VI. Primary endpoint was: hospital admission for cardiovascular causes or death during 12 months follow-up (group A) or during 12 months follow-up after VI (group B). Statistical analysis of clinical and echocardiographic data was made. <br /> Results: we included 72 patients, mean age 79.09±6.35 years, 58.3% were female. The majority had history of hypertension (80.6%), and less than half had type 2 diabetes mellitus and coronary artery disease (43.1% and 26.4% respectively). Most of them (81.7%) were symptomatic, mainly presenting with HF (76.4%). Less than a quarter (23.6%) had LVEF < 50%; 34.7% had evidence of PH and 23.6% of right ventricular dysfunction. About half of the pts (52.8%) underwent VI, mainly surgical valve replacement (76.31%). Pts undergoing VI were younger (group A 79.57±7.32 vs group B 78.25±5.06 years, p=0.006) and had higher creatinine clearance (group A 46.86±17.69 vs group B 57 ± 30.33 mL/min, p=0.018).</p> <p>The mortality rate during follow-up was 19.2%. About one third of the pts reached the endpoint (26.4%), mostly pts with systemic hypertension (p=0.007), PH (p=0.044) and pts from group A (p=0.001). Only PH (Odds ratio = 6.24 [95% CI 1.22-31.85], p=0.013) and absence of VI (group A) (Odds ratio = 7.69 [95% CI 1.62-58.80], p=0.028) were independent predictors of the endpoint.</p> <p>Considering only pts with PH, absence of VI significantly decreased time to endpoint (group A 6,67±1.11 months vs group B 10,9±1.04 months, p= 0.005).<br /> Conclusion: VI is essential to improve the adverse prognosis of pts with SAS. Despite their worse prognosis, pts with PH still benefit from VI, with a relevant improvement in survival and quality of life. </p>
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