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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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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
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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
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14. Acute Cardiac Care
15. Valvular Heart Disease
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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
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34. Public Health and Health Economics
35. Research Methodology
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Looking beyond Left Ventricular Ejection Fraction - a new multiparametric CMR score to refine the prognostic assessment of HF patients
Session:
Prémio Jovem Investigador
Speaker:
Gonçalo José Lopes Da Cunha
Congress:
CPC 2021
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Resonance
Session Type:
Prémios
FP Number:
---
Authors:
Gonçalo Lopes Da Cunha; Bruno Rocha; João Adriano Sousa; Sérgio Maltês; Catarina Brízido; Christopher Strong; Sara Guerreiro; João Abecasis; Maria João Andrade; Carlos Aguiar; Carla Saraiva; Pedro Freitas; Miguel Mendes; António Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:#333333">Background: </span></strong><span style="color:#333333">Cardiac magnetic resonance (CMR) </span>is recommended in Heart Failure (HF) to assess myocardial structure and function. Recently, the quantification of pulmonary congestion and skeletal muscle mass using CMR have been shown to predict adverse events in HF, but a tool integrating this information is currently unavailable. The purpose of this study was to develop and test a new multiparametric CMR-derived score.</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:#333333">Methods: </span></strong><span style="color:#333333">We conducted a single-center retrospective study of consecutive HF patients with left ventricular ejection fraction (LVEF) <50% who underwent CMR. Several CMR parameters with known prognostic value were assessed, including: LVEF, Lung Water Density (LWD), Pectoralis Major Muscle (PMM) area, and presence of Late Gadolinium Enhancement. PMM area was outlined at the level of the carina – </span><strong><span style="color:#0070c0">figure 1-A, B</span></strong><span style="color:#333333"> – and LWD was defined as the lung-to-liver signal ratio multiplied by 0.7, as previously described. Both parameters were measured in standard HASTE images -</span><strong><span style="color:#0070c0"> figure 1-C</span></strong><span style="color:#333333">. The primary endpoint was a composite of all-cause death or HF hospitalization. Using the Cox regression Hazard Ratios of designated variables, a risk score was developed. </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:#333333">Results: </span></strong><span style="color:#333333">Overall, 436 patients were included – </span><strong><span style="color:#0070c0">table 1</span></strong><span style="color:#333333">. During a median follow-up of 27 (17-37) months, 43 (9.9%) patients died and 57 (13.2%) had at least one hospitalization for HF. LVEF, LWD and PMM were independent predictors of the primary endpoint and were included in the CMR-HF score – </span><strong><span style="color:#0070c0">figure 2</span></strong><span style="color:#333333">. The annual rate of events increased from 4.7 to 7.5 and 20.0% from lowest to highest tertile of the score. Roughly half of the events (54%) occurred in patients in the highest tertile of the CMR-HF score. In multivariate analysis, the new score independently predicted the primary endpoint (HR per 5 points: 1.54; 95% CI: 1.21-1.97; p <0.001) even after adjustment for age, body mass index, NYHA class, NT-proBNP, estimated glomerular filtration rate, presence of implantable cardioverter-defibrillator, and ischemic etiology.</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:#333333">Conclusions: </span></strong><span style="color:#333333">This novel multidimensional CMR-HF score, combining easily obtainable data on left ventricular pump failure, lung congestion and muscular wasting, is a promising tool identifying HF patients with an LVEF <50% at higher risk of death or HF hospitalization. </span></span></span></p>
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