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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
36. Basic Science
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Severe aortic stenosis in a real-world setting Remover
Session:
Posters 5 - Écran 8 - Doença Valvular
Speaker:
Rita Ventura Gomes
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:
Rita Ventura Gomes; Antonio; Bruno M. Rocha; Ana Rita F. Pereira; Daniel Sebaiti; Ana I. Marques; Dra. Inês Cruz; Isabel João; Helder Pereira; Ana Almeida
Abstract
<p><strong>Introduction</strong></p> <p>Severe aortic stenosis (SAS) is now frequently diagnosed in asymptomatic patients (AP). Unlike symptomatic patients (SP), AP have a low risk of complications and intervention is seldom indicated. The current guidelines recommend aortic valve replacement (AVR) for SP with SAS.</p> <p><strong>Purpose</strong></p> <p>To evaluate the baseline characteristics, therapeutic strategies and the long-term outcomes of SP and AP with SAS in a real­-world setting.</p> <p><strong>Methods</strong></p> <p>Retrospective cohort study of AP and SP pts with SAS (mean transvalvular pressure gradient (MG) >=40 mmHg or a peak transvalvular velocity (PTV) >=4.0 m/s), with both preserved and reduced left ventricular ejection fraction (LVEF), who were examined in our echo lab between January 2015 and December 2016. Median follow-up (FU) 2,6 years (IQR 2,2–2,9).</p> <p>The primary outcome was a composite of cardiovascular death or heart failure hospitalization.</p> <p><strong>Results</strong></p> <p>150 pts with SAS were included (age 76,6±9,0years, 28,0% men; aortic valve area 0,72±0,18cm2; PTV 4,3m/s, IQR 4,1-4,7; MG 44,0mmHg, IQR 40,0-53,5; LVEF 57,2±10,4%).</p> <p>Symptoms were documented in 97 pts. The SP had more SAS (PTV 4,5±0,5vs4,3±0,4m/s, p<0,0001; MG 46,7,IQR 41,0-57,5vs41,8,IQR 39,0-45,0mmHg, p=0,001).</p> <p>AVR (surgical n=63; TAVI n=12) was performed in 67,0% (n=65) SP and 18,9% (n=10) AP (p<0,0001), while the remainder with a formal indication (n=36,35,6%) were managed conservatively. Four AP (57,1%) did not undergo AVR, although they had indication (2pts refused, 1 died, 1 due to comorbidities). The AVR was not performed in the SP group mostly due to comorbidities (n=12,37,5%) and refusal (n=9,28,1%).</p> <p>Thirty pts (20%) had at least one event of the primary outcome. There were no differences in the SP and AP groups (22,7%vs15,1%, p=0,267). However, SP and AP who underwent to AVR had fewer events (9,3%vs30,7%, p = 0,001).</p> <p>Pts with at least one event had less AVR (76,7%vs23,3%, p=0,001), higher estimated PASP (47,9±17,4vs37,4±14,9mmHg, p=0,007) and lower TAPSE (19,6±4,6vs22,5±4,1mm, p=0,02). Only the AVR was predictive of the outcome (HR 0,127, CI 0,02-0,821, p=0,03). </p> <p><strong>Conclusion</strong></p> <p>In a real-world experience, SAS has a high rate of adverse events. Few differences were observed between SP and AP.</p> <p>The AVR had a significant impact in the outcome, regardless of symptoms, thus implying that selected AP may as well benefit from this intervention. Nonetheless, in a real-world setting, more than one-third of the patients with a formal indication for intervention was conservatively treated.</p>
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