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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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07. Syncope and Bradycardia
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Measurement of maximum LV wall thickness by CMR and echocardiography and its impact in HCM Risk-SCD
Session:
Painel 9 - Doença Valvular 5
Speaker:
Ana Neto
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.7 Myocardial Disease - Other
Session Type:
Posters
FP Number:
---
Authors:
Ana Leal Neto; Inês Pereira Oliveira; Isabel Martins Da Cruz; Daniel Seabra De Carvalho; Rui Pontes dos Santos; Aurora Andrade; Paula Pinto
Abstract
<p><strong>Introduction: </strong>The HCM Risk-SCD estimates the risk of sudden cardiac death at 5 years in patients (pts) with hypertrophic cardiomyopathy (HCM). Implantable cardioverter defibrillator (ICD) indication is decided according to risk stratification, as stated by ESC Guidelines. The association between the degree of left ventricular hypertrophy (LVH) and sudden cardiac death has been based on measurements of maximum left ventricular wall thickness (LVWT) by echocardiography which is part of HCM Risk-SCD score. However, cardiac magnetic resonance (CMR) has shown a superior resolution in characterization of cardiac structures, with additional role in SCD risk stratification. Whether measurements of LVWT by echocardiography and CMR are interchangeable has been brought to question.</p> <p><strong>Purpose: </strong>We sought to evaluate the incidence of discrepant measurements of maximal LVWT between echocardiography and CMR and determine its implication in HCM Risk-SCD score and ICD indication.</p> <p><strong>Methods:</strong><strong> </strong>Unicentric, retrospective analysis of pts submitted to CMR who had HCM as definitive diagnosis, between 1/2013 and 9/2019. CMR and echocardiographic measures were compared, as well as HCM Risk-SCD score calculated with these values (maximum LVWT was the only variable that differed between measures). Subsequently, pts were divided in three groups according to HCM Risk-SCD score: pts with a 5-year risk of SCD <4% (G1), risk of 4 to less than 6% (G2) and risk ≥6% (G3).</p> <p><strong>Results: </strong>Out of the 781 CMR studies evaluated, 59pts were found to have HCM (7.6%). Mean age of 62±11years, female predominance (50.8%). 12pts had obstructive phenotype (20.3%). Mean LVWT was 20.0±4.6mm when measured by CMR and 18.8±4.6mm by echo; when comparing the measures by echo with CMR, there was a positive correlation between them (p<0.001; r 0.719). Mean HCM Risk-SCD was 2.80±1.51% when measured by CMR and 2.69±1.53% by echo; there was a positive correlation between these measures too (p<0.001; r 0.963). Only 1pt changed risk group with CMR measurement of maximum LVWT (from G1 to G2).</p> <p><strong>Conclusion: </strong>In this cohort, there was a positive, linear relationship between maximum LVWT and HCM Risk-SCD score measured by CMR and echocardiogram. Only 1pt changed risk stratification group (5-year risk of SCD <4% to 4 to less than 6%). Although CMR measurements, when interpreted correctly, are more precise compared with echocardiography, in this cohort there was no impact in patient's future clinical orientation regarding ICD implantation.</p>
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