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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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How to predict atrial fibrillation in mitral valve prolapse patients?
Session:
Painel 3 - Imagiologia Cardiovascular 3
Speaker:
Tiago Graça Rodrigues
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Tiago Graça Rodrigues; Joana Rigueira; Inês Aguiar Ricardo; Rafael Santos; Nelson P. Cunha; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Beatriz Silva; Pedro Alves Da Silva; Rui Plácido; Cláudio David; Susana Gonçalves; Fausto José Pinto; Ana G. Almeida
Abstract
<p><strong>Introduction/objective: </strong>Development of atrial fibrillation (AF) is a common event in the natural course of mitral valve prolapse (MVP), and it is an established factor of worsening prognosis. The mechanisms leading to the development of atrial fibrillation MVP are still under investigation. </p> <p> </p> <p><strong>Aim</strong>: To established prognostic risk factors for AF in MVP patients.</p> <p> </p> <p><strong>Methods</strong>: A single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined as systolic displacement of the mitral leaflet into the left atrium≥2 mm from the mitral annular plane. Demographic, clinical, echocardiographic, electrocardiographic data were collected as well as AF development at follow-up. The results were obtained using Chi-square and Student-t tests; logistic regression was used to find predictors of death.</p> <p> </p> <p> </p> <p><strong>Results: </strong>247 patients were included (mean age 62.9 ± 18 years, 61% males), 17,8% with hypertension and 47.4% with significant mitral regurgitation (>moderate). The posterior mitral valve leaflet (PL) was the most frequently involved (49%), followed by involvement of both leaflets (BL) (27%) and the anterior leaflet (AL) (25%). During a mean follow-up of 30 ± 19 months, 27.1% had AF and it was associated with mitral valve intervention and was a predictor of hospitalization(OR=2.57, CI95% 1.15-5.75, p=0.022). </p> <p>Patients with AF were older (72 ±13 vs 59 ±19 years, p<0.001), with high systolic pulmonary artery pressure (SPAP) (p=0.012), were in higher NYHA functional class (p<0.001) and had higher mortality (16.1 vs 6%, p<0.001). In addition, they had higher left ventricle (LV) mass (p<0.001), posterior wall (p<0.001) and interventricular septum thicknesses (p=0.003), but there was no difference in hypertension between groups. All of the previous variables were predictors of AF in univariate analysis. The QRS and cQT interval duration were also associated with AF (p=0.026 and p=0.02, respectively) and were predictors of AF in univariate analysis (OR=1.015, CI95% 1.001-1.029, p=0.03 and OR=1.011, CI95% 1.002-1.021, p=0.023, respectively). </p> <p>In multivariate analysis, SPAP (OR=1.04 CI95% 1.004-1.066, p=0.009), LV mass (OR=1.021, CI95% 1.008-1,035, p=0.002) and NYHA class > II (OR=4.742, CI95% 1.053-21.348, p= 0.043) were independent predictors of AF in our patients.</p> <p>The presence of mitral annulus disjunction and the location of the prolapse had no association with AF in our population.</p> <p> </p> <p><strong>Conclusion: </strong>AF has an important impact in the prognosis of MVP patients namely in intervention and hospitalizations. In our patients SPAP, LV mass and NYHA functional class> II were independent predictors of AF, suggesting that the optimization of hypertension and heart failure treatment in these patients might have a role in MVP natural history. </p>
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