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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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Abstract
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Does the gender influence in mitral valve prolapse clinical presentation?
Session:
Posters - B. Imaging
Speaker:
Ana Margarida Martins
Congress:
CPC 2021
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Margarida Martins; Joana Rigueira; Tiago Rodrigues; Nelson Cunha; Sara Couto Pereira; Pedro Silvério António; Pedro Alves da Silva; Beatriz Valente da Silva; Joana Brito; Beatriz Garcia; Catarina Oliveira; Luís Brás Rosário; Rui Plácido; Claudio David; Fausto j. Pinto; Ana g. Almeida
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: The impact of gender in mitral valve prolapse (MVP) is not clearly defined with some contradictory findings published. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To evaluate gender differences in clinical characteristics, predictors of events and outcomes in patients (pts) with MVP. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Single-center retrospective study of consecutive pts with MVP found in transthoracic echocardiogram from January 2014 - October 2019. MVP was defined according to 2017 AHA recommendations, the ESC classification considering the leaflet tip position was also evaluated. Demographic, clinical, echocardiographic, ECG data were collected, as well as adverse events at follow-up (FUP). The results were obtained using X</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> and student-T tests, logistic regression and Receiver Operator Curve.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: 247 pts were included (mean age 63 ± 18 years, 61% male). According to ESC classification, the frequency of prolapse was similar between men and women (61 vs 59%, p=NS), flail was more common in men (16 vs 6%, p=0.028) and billowing in women (35% vs 22%, p=0.04). </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Male pts had more aortic dilatation (83 vs 14%, p=0.001), interventricular septum (10.8 ± 1.8mm vs 9.5 ± 1.7mm) and posterior wall thickness (10.4 ± 1.8mm vs 9.0 ± 1.7mm) (both p<0.001). Also, in ECG there were differences between gender, with men having more intraventricular conduction disturbances (p=0.014) and higher QRS duration (104 ±24ms vs 99 ± 20ms, p=0.008).</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">There were no statistically significant differences in death, mitral intervention or arrhythmias during the 30 ± 19 months of FUP.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Predictors of mitral intervention differed between gender: in men the maximum </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"><span style="background-color:#ffffff">leaflet displacement</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> of MVP was an independent predictor (OR=1.345, CI 1.129-1.605 p=0.001) with a</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121"><span style="background-color:#ffffff"> low-moderate capacity of prediction (AUC 0.68 p=0.001); best cut-off was 7.5mm (Sens=62%, Spec=70.5%) – Fig.1. On the other hand, in women, the cQT interval was a predictor of mitral intervention </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">(OR=1.02, CI 1.001-1.04, p=0.049) with a</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121"><span style="background-color:#ffffff"> moderate prediction capacity (AUC 0.74 p=0.004); best cut-off was 416ms (Sens=81%, Spec=65%)- fig 2. </span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121"><span style="background-color:#ffffff">In men, the presence of billowing </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">(OR=7.3, CI 1.2-42.7 p=0.028) and RBBB (OR=12.9, CI 1.9-89.4 p=0.009) </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121"><span style="background-color:#ffffff">were independent predictors of death. In women the presence of LBBB </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">(OR=26.7, CI 1.58-450.9 p=0.023) </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121"><span style="background-color:#ffffff">was an independent predictor of death. </span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121"><span style="background-color:#ffffff">In men, flail </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">(OR=1.04, CI 1.01-1.07 p=0.002), LV mass (OR=1.02, CI 1.01-1.03 p=0.004) and age (OR=1.04, CI [1.01-1.07], p=0.002) were independent predictors of arrythmias during follow-up, and the QTc interval was a predictor of atrial fibrillation (OR=1.02, CI 1.004-1.041 p=0.015) and this was not true for women. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> In our study, MVP was more common in men. Males had more flail, aortic dilatation and interventricular conduction disturbances. Billowing was more common in women. The clinical phenotype of pts with MVP seems differ between gender, however, here these differences had no impact in the prognosis. </span></span></span></p>
Slides
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