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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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Ischemia in dobutamine stress echocardiography – When does it occur?
Session:
Posters 5 - Écran 7 - Imagiologia Cardiovascular
Speaker:
Vera Vaz Ferreira
Congress:
CPC 2019
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Vera Ferreira; Luisa Moura Branco; Ana Galrinho; Pedro Rio; Sílvia Aguiar Rosa; Ana Leal; Duarte Cacela; Alexandra Castelo; Pedro Garcia Brás; Tânia Branco Mano; João Pedro Reis; Rui Cruz Ferreira
Abstract
<p><strong>Introduction:</strong> The assessment of new wall motion abnormalities using dobutamine stress echocardiography (DSE) improves the sensitivity to detect coronary artery disease (CAD) and the stratification of cardiac events.</p> <p><strong>Purpose: </strong>To evaluate predisposing factors to myocardial ischemia during DSE.</p> <p><strong>Population and methods:</strong> 220 patients (P) who underwent consecutive DSE for suspected coronary artery disease (CAD) between 2013 and 2017. P with significant valvular disease were excluded from this study. P were divided according to DSE result: positive (+) and negative (-). We evaluated clinical and echocardiographic characteristics and determined predictors for myocardial ischemia. Mean age was 64.8±12.0 years, with 143 men (65%).</p> <p><strong>Results: </strong>88 P (46.3%) were included in +DSE and 102 P (53.7%) in -DSE. 30 P were excluded due to an inconclusive DSE. +DSE had more male (79.5% vs 55.9%;p=0.001), dyslipidemia (80.5% vs 62.0%;p=0.006), prior myocardial infarction (MI) (48.3% vs 25.8%;p=0.002), prior percutaneous coronary intervention (38.6% vs 23.5%;p=0.025), prior coronary bypass graft (CABG) (20.5%vs2.9%;p=0.001) and antiplatelet therapy (76.7% vs 62.5%,p=0.041). +DSE P had smaller ejection fraction (EF) (EF<50% +DSE 63.6 vs 17.4% in -DSE ;p=0.001), larger left ventricular (LV) end-systolic and end-diastolic dimensions (38.4±9.3 vs 29.1±6.9 mm; p<0.0005 and 55.8±7.3 vs 49.9±5.9mm;p<0.0005), larger left atrial dimension (41.6±5.3 vs 38.5±6.2mm; p=0.007) and higher pulmonary artery pressure (34.7±12.0 vs 29.7±7.3mmHg; p=0.047). In +DSE, 75% P had resting wall motions abnormalities (WMA) (vs 16.7% in -DSE; p<0.0005) and the mean peak wall motion score index was 1.47±0.36 (vs 1.04±0.13 in -DSE; p<0.0005). Mean resting global longitudinal strain (GLS) was smaller in +DSE (-15.0±4.3 vs -17.9±3.9 in -DSE; p=0.033) as well as mean peak GLS (-14.7±4.1 vs -19.0±3.5; p=0.010). Significant intraventricular gradient (IVG>20mmHg) was exhibited in 36.3% in -DSE (vs 9.1% in +DSE; p<0.0005). In multivariate analysis, independent predictors for ischemia in DSE were dyslipidemia (OR 3.26; p=0.011), prior CABG (OR 5.83; p=0.039), absence of IVG (OR=0.30; p=0.032) and rWMA (OR 7.24; p<0.0005).</p> <p><strong>Conclusion: </strong>Predictors for ischemia in patients underwent DSE were the presence of risk factors (dyslipidemia), occurrence of previous coronary events (prior CABG and resting wall motion abnormalities) and the absence of intraventricular gradient.</p>
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