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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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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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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Spongy myocardium or left ventricular noncompaction: which factors impact prognosis?
Session:
Posters (Sessão 5 - Écran 3) - Doenças do Miocárdio e Pericárdio 2
Speaker:
José Miguel Ramos Viegas
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
José Miguel Viegas; Silvia Aguiar Rosa; Pedro Brás; Isabel Cardoso; Pedro Rio; Ana Teresa Timóteo; Ana Galrinho; Luísa Moura Branco; Rui Cruz Ferreira
Abstract
<p>Introduction: The presence of prominent left ventricular (LV) trabeculation fulfilling noncompaction cardiomyopathy (LVNC) criteria on routine echocardiogram is frequently encountered; however the prognostic significance of these findings remains uncertain.</p> <p>Objectives: To identify clinical and echocardiographic features associated with adverse clinical events in patients (P) with LVNC phenotype.</p> <p>Methods: Retrospective analysis of all P satisfying LVNC criteria assessed by Chin and Jenni methods between January 2018 and June 2020 in a single tertiary care centre. Endpoint was composite of cardiovascular death, heart failure hospitalization, ventricular arrythmias and nonfatal stroke. Several possible prognostic factors were evaluated by Cox regression.</p> <p>Results: 32P, 75% male, mean age 45±18 years. 21P (66%) had associated heart conditions, mainly dilated cardiomyopathy (10P), followed by ischemic, congenital and valvular heart disease. 2P were in postpartum period and 1P was an athlete. Family history of cardiomyopathy was present in 6P (19%). Genetic testing performed in 8P demonstrated variants in TTN (3P), MYH6, MYH7, PNPLA2, RBM20, and DSP genes. Mean NYHA classification was 1.9±0.8, with 31% in NYHA I. Regarding echocardiographic parameters, LV end-diastolic and end-systolic volume index (LVESVI) were 84 (41) and 51 (37) ml/m2, respectively, LV ejection fraction (LVEF) 39±12%, global longitudinal strain (GLS) -11±5%, and pulmonary artery systolic pressure (PASP) 39±13mmHg. Mean number of affected segments 6.4±1.8, with hypertrabeculation most noticeable in apical and lateral segments.</p> <p>Over a mean follow-up of 18±8 months, survival free of composite endpoint was 50%. In unadjusted Cox regression, hypertension (p= 0.034), chronic kidney disease (p= 0.048), NYHA class (p <0.001), LVESVI (p= 0.042), LVEF (p= 0.002), GLS (p= 0.022) and PASP (p= 0.017) were associated with increased incidence of events. ECG parameters, laboratory markers, RV function, number of affected segments and extension of noncompacted layer did not significantly influence outcomes. After covariate adjustment, NYHA class (HR: 3.203, 95%CI: 1.212-7.128, p= 0.016) and LVEF (HR: 0.910, 95%CI: 0.825-0.953, p= 0.035) (Fig.1) remained independent predictors of adverse events.</p> <p>Conclusion: P satisfying criteria for LVNC had heterogeneous clinical and morphological characteristics. NYHA class and LVEF were associated with worse outcomes. The number of affected segments and extension of noncompacted layer were not related with the prognosis.</p>
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