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Asymptomatic severe aortic stenosis: what is the current role of Exercise Stress Test and NT-proBNP in patient risk stratification
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Isabel Campos
Congress:
CPC 2021
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:
Isabel Durães Campos; Joana Pereira; Nuno Salome; Cátia Oliveira; Paulo Medeiros; Carla Marques Pires; Rui Flores; Fernando Mané; Rodrigo Silva; Jorge Marques; Catarina Vieira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:NewsGotT">Introduction:</span></span></strong><span style="font-size:12pt"><span style="font-family:NewsGotT"> Aortic stenosis (AS) is prevalent in the elderly population. When severe and the patient is symptomatic or left ventricular dysfunction arises, the prognosis deteriorates and valve replacement (AVR) is recommended. During the asymptomatic phase regular clinical evaluation is advised to detect early onset of symptoms and/or signs of myocardial maladaptation. Due to the inherent difficulties in the evaluation of symptoms, especially in the elderly, as well as the change in prognosis when symptoms appear (even if not perceived), it is crucial to evaluate the behavior of patients with effort and signs of myocardial injury.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:NewsGotT">Methods:</span></span></strong><span style="font-size:12pt"><span style="font-family:NewsGotT"> An observational and retrospective study that included 74 patients with severe AS (aortic valve area ≤ 1cm<sup>2</sup>and/or aortic transvalvular mean gradient ≥40mmHg), who underwent exercise stress test and NT-proBNP evaluation for risk stratification. The outcome studied was hospitalization for heart failure (HF), or referral to SV, or death during the follow-up period. Independent predictors were obtained using multivariate Cox regression.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:NewsGotT">Results:</span></span></strong><span style="font-size:12pt"><span style="font-family:NewsGotT"> Non-progression or decrease in systolic blood pressure in exercise stress test is the only independent predictor of a short-term adverse event (p = 0.025). This parameter, NT-proBNP levels and interventricular septal thickness were independent predictors of a medium (two (p = 0.025; p = 0.014; p = <0.001), three (p = 0.015; p = 0.007; p = 0.001) and four years (p = 0.007; p = 0.049; p = 0.005)) and a long term adverse event (p = 0.006; p = 0.028; p = 0.005).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:NewsGotT">Conclusion:</span></span></strong><span style="font-size:12pt"><span style="font-family:NewsGotT"> In asymptomatic patients with severe AS, no progression or decrease in systolic blood pressure in exercise stress test, increased NT-proBNP levels and thickness<strong> </strong>of interventricular septal thickness were independent predictors of hospitalization for HF, need for AVR or death in short, medium and long term. </span></span></span></span></span></p>
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