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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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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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32. Cardiovascular Nursing
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Abstract
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CLEAR FILTERS
Moderate aortic stenosis: not as benign as it seems
Session:
Posters (Sessão 2 - Écran 7) - Ecocardiografia
Speaker:
Catarina Oliveira
Congress:
CPC 2023
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Catarina Simões De Oliveira; Joana Brito; Pedro Alves da Silva; Beatriz Valente da Silva; Beatriz Garcia; Ana Margarida Martins; Catarina Gregório; Ana Abrantes; Miguel Raposo; Marta Vilela; Daniel Cazeiro; Joana Rigueira; Rui Plácido; Fausto J. Pinto; Ana Almeida
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Severe aortic stenosis (AS) represents an important cause of morbidity and mortality, being aortic valve replacement the cornerstone for prognostic shift. Although mild and moderate AS are regarded as low risk, its benign course has recently been challenged. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: to evaluate cardiovascular (CV) events and identify prognostic factors in patients (pts) with moderate AS. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Single center observational study of pts with moderate AS in consecutive echocardiographic evaluations, during a minimum follow-up (FUP) of 3 years. Clinical characteristics and laboratory and echocardiographic data were collected at baseline and during follow-up (FUP). Analyzed events at FUP included pre-syncope/syncope, chest pain, dysrhythmic episodes, hospital admission due to heart failure (HF), death and CV death. Statistical analysis was performed using Chi-square and Mann-Whitney tests. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: a total of 78 pts (74±10 years; 52.6% males), were monitored during a mean FUP of 47±16 months. The main CV risk factors were systemic arterial hypertension (83.3%), hypercholesterolemia (66.7%) and diabetes (41%). Atrial fibrillation was present in 39.8% of pts. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">At baseline, the mean left ventricular ejection fraction (LVEF) was </span>62±8,6% and LV mass index (LVMI) was 118±30 g/m2. At FUP, NTproBNP was 7879 pg/ml and echocardiographic evaluation depicted a <span style="font-size:12.0pt">LVEF of </span>59±9.6% and a LVMI of 131±36 g/m2 (table 1). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> At FUP, 6% of pts had pre-syncope/syncope, 13% chest pain and about 5% presented with a dysrhythmic episodes, namely complete atrioventricular block and ventricular ectopic beats. All patients with dysrhythmias had a mean aortic gradient greater than 30 mmHg (p=0.030). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> Lower LVEF at baseline (p=0.005), greater index LVMI at baseline (p=0.021) and at FUP (p= 0.016) and right ventricular dysfunction at FUP (p= 0.048) correlated with hospital admission due to HF (28% of pts). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During FUP, 29% of pts died, 14% from CV cause. Greater LVMI at baseline (p=0.046) and at FUP (p=0.032) and worse LVEF at baseline (p=0.016) were associated with death, while a higher LVMI at baseline (p=0.034) showed correlation with CV death. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: Contemporary risk stratification of moderate AS is still incipient. However, less than severe AS is associated with CV events and death. In our population, about 1/3 of pts died at mean 4 years FUP, half of them from CDV death, although they didn’t progress to severe AS. Further investigation is warranted to assess whether earlier intervention could improve outcomes in this subset of pts.</span></span></p>
Slides
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