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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
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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
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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
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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
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Cardiac damage in a real-world severe aortic stenosis population
Session:
Painel 9 - Doença Valvular 1
Speaker:
Rita Ventura Gomes
Congress:
CPC 2020
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; Ana Rita F. Pereira; Daniel Sebaiti; Inês Cruz; Ana Almeida; Isabel João; Helder Pereira
Abstract
<p><strong>Introduction: </strong>The cardiac consequences of aortic stenosis, besides left ventricular ejection fraction and systolic pulmonary artery pressure, aren’t considered in the recommendations for surgical intervention in patients (pts) with severe aortic stenosis (SAS). In 2017 a new staging echo classification was presented to accurately describe them.</p> <p><strong>Purpose: </strong>To evaluate this new echo classification in risk stratification of pts with SAS with or without AVR, in a real­-world setting.</p> <p><strong>Methods: </strong>Retrospective cohort study of pts with SAS (mean transvalvular pressure gradient (MG)³40 mmHg or a peak transvalvular velocity (PTV)³4.0 m/s), who were examined in our echo lab between January 2014 and December 2016. Pts were classified according to new staging echo classification (no extravalvular cardiac damage - Stage 0, left ventricular damage - Stage 1, left atrial or mitral valve damage - Stage 2, pulmonary vasculature or tricuspid valve damage - Stage 3, or right ventricular damage - Stage 4). Follow-up (FU) was 2.6±1.0 years. The primary outcome was a composite of cardiovascular death or heart failure hospitalization.</p> <p><strong>Results: </strong>212 pts with SAS were included (age 76.1±9.1years, 31.6% men; aortic valve area 0.69±0.21cm<sup>2</sup>; PTV 4.5±0.4m/s; MG 48.5±11.6mmHg; LVEF 58.8±12.2%).</p> <p>19 (9.0%) pts were classified as Stage 0, 29 (13.7%) as Stage 1, 129 (60.8%) as Stage 2, 12 (5.7%) as Stage 3 and 23 (10.8%) as Stage 4.</p> <p>Pts with more advanced stages had more events (stage 0: 5.3%; stage 1: 10.3%; stage 2: 17.1%; stage 3: 50.0%; stage 4: 52.2%; p<0.0001). In the multivariate analysis, the classification system was also a predictor of the outcome, even when including the AVR in the model (Table 1).</p> <p>Similar findings in the uni and multivariate analysis were identified when analyzing only the pts with SAS and no aortic intervention (events in stage 0: 16.7%; stage 1: 18.2%; stage 2: 29.3%; stage 3: 75.0%; stage 4: 64.7%, p<0.005; Figure 1).</p> <p><strong>Conclusion: </strong>In a real-world experience, the new staging echo classification presented by Généreux et al. showed a significant relationship between the extent of cardiac damage at baseline and the primary outcome in pts with SAS, even after controlling for AVR. This classification was also able to identify the SAS pts who did not perform AVR and had a significant risk of adverse events.</p>
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