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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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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
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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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Clinical outcomes in HFrEF and good functional capacity: the deception of stability
Session:
Sessão de Comunicações Orais - Insuficiência Cardíaca
Speaker:
Sérgio Maltês
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sérgio Maltês; Bruno M. Rocha; Gonçalo Lopes Da Cunha; João Presume; Francisco Albuquerque; Pedro Lopes ; Francisco Fernandes Gama; Pedro Freitas; Anai Durazzo; António Tralhão; António Ventosa; Carlos Aguiar; Miguel Mendes
Abstract
<p><strong>Background:</strong></p> <p>Cardiopulmonary stress test (CPET) is recommended in Heart Failure (HF) risk stratification, as peak O<sub>2</sub> consumption (pVO<sub>2</sub>), minute ventilation/carbon dioxide production (VE/VCO<sub>2</sub>) slope and exercise oscillatory ventilation (EOV) identify patients at risk of major events. The aim of this study was to assess clinical outcomes in seemingly low-risk HF patients (i.e., pVO2 ≥18mL/Kg/min) with reduced left ventricular ejection fraction (LVEF).</p> <p><strong>Methods:</strong></p> <p>This is a single-center retrospective observational study enrolling consecutive HF patients with LVEF<40% who performed a CPET between 2003-2018 and had a pVO<sub>2 </sub> ≥18mL/kg/min. The primary endpoint was a composite of all-cause death or HF hospitalizations.</p> <p><strong>Results:</strong></p> <p>Overall, 101 patients (mean age of 53.2 ± 10.3 years; 86% male; 39.8% with hypertension and 10.7% diabetes mellitus; 47.6% ischemic HF) with a mean LVEF of 30.5 ± 5.9% were assessed. At baseline, mean pVO<sub>2 </sub>was 22.0 ± 3.3 ml/kg/min, median VE/VCO2 was 32.0 (IQR: 29.0-36.0) and 25 patients (24.8%) had EOV. NTproBNP was >125 pg/mL in 92% patients, and >600 pg/mL in 36%. The median NT-proBNP was 427 (IQR 221-745) pg/mL (figure 1). Over a median follow-up of 67.0 (IQR: 17.0-124.0) months, 33 (32.7%) patients met the primary endpoint: 16 (15.8%) patients died and 19 (18.8%) had at least one HF hospitalization, with approximately 20% of events happening in the first three years after the CPET (figure 2).</p> <p><strong>Conclusion:</strong></p> <p>In a seemingly low-risk population with HF and LVEF <40%, the vast majority showed persistent neurohormonal activation, and one in every three patients had a major cardiovascular event over a median follow-up of roughly 5 years. These findings support optimization of evidence-based treatment and resisting treatment inertia in HF with reduced LVEF, even when patients are clinically stable and present a good functional class. </p>
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