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A. Basics
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01. History of Cardiology
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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
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23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
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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
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Predicting obstructive coronary artery disease in heart failure – a practical clinical score
Session:
CO 10 - Insuficiência cardíaca crónica
Speaker:
Francisco Albuquerque
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Francisco Albuquerque; Afonso Félix Oliveira; Pedro de Araújo Gonçalves; Rui Campante Teles; Manuel de Sousa Almeida; Mariana Gonçalves; Pedro m. Lopes; Gonçalo J.L. Cunha; João Presume; Daniel Matos; Sérgio Madeira; João Brito; Luís Raposo; Henrique Mesquita Gabriel; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:black">Background: </span></strong><span style="color:black">Coronary</span><span style="color:black"> artery disease (CAD) remains the most common etiology of heart failure with reduced ejection fraction (HFrEF). However, controversy exists whether invasive coronary angiography (ICA) should be initially used to exclude CAD in patients presenting with <em>de novo</em> heart failure. The aim of our study was to develop a clinical score to quantify the risk of obstructive CAD in these patients.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:black">Methods: </span></strong><span style="color:black">Cross-sectional observational study of 22,383 consecutive patients </span><span style="color:black">undergoing elective ICA in one academic center, between January 2005 and December 2019. Predefined exclusion criteria were applied to derive a total cohort of 452 patients with HFrEF without known CAD. </span><span style="color:black">Independent predictors for obstructive CAD were identified. Using multivariate logistic regression of designated variables, a risk score was developed. The accuracy and discriminative power of the predictive model were assessed. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:black">Results: </span></strong><span style="color:black">109 patients (24.1%) presented obstructive CAD. Six independent predictors were identified and included in the score: male sex (2 points), diabetes mellitus (1 point), dyslipidemia (1 point), smoking (1 point), peripheral artery disease (1 point) and regional wall motion abnormalities (3 points). </span><span style="color:black">Patients with a score </span><span style="font-family:Symbol"><span style="color:black">£</span></span><span style="color:black"> 3 had less than 15% of predicted probability of obstructive CAD. Our score showed good discriminative power (C-statistic 0.872; 95% CI 0.834 – 0.909: p-value < 0.001) and calibration (p-value from the goodness-of-fit test of 0.333). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:black">Conclusions: </span></strong><span style="color:black">A simple clinical score showed the ability to predict the risk of obstructive CAD in patients presenting HFrEF and may guide the clinician selecting the most appropriate diagnostic modality for the evaluation of obstructive CAD in this patient population.</span></span></span></p>
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