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Predictors of coronary artery disease in acute heart failure patients: do they all benefit from invasive coronary angiography?
Session:
SESSÃO DE POSTERS 08 - DOENÇAS CARDIOVASCULARES - PROGNÓSTICO NO SCA
Speaker:
Mauro Moreira
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.3 Acute Heart Failure – Diagnostic Methods
Session Type:
Cartazes
FP Number:
---
Authors:
Mauro Moreira; José Luís Ferraro; Ana Rodrigo Costa; Inês Gomes Campos; Rafaela G. Lopes; Joel Ponte Monteiro,; Adriana Pereira; Aurora Andrade
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Introduction: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Coronary artery disease (CAD) is highly prevalent in heart failure (HF), posing diagnostic and management challenges due to overlapping manifestations. Despite advances, uncertainty remains regarding CAD assessment and revascularization in HF patients.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Methods: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Single-centre, retrospective study with acute heart failure (AHF) patients undergoing invasive coronary angiography (ICA). Acute coronary syndrome cases were excluded. History, symptoms, biomarkers, electrocardiogram (ECG) and echocardiogram findings were compared. A composite endpoint (CE) included revascularization, antiplatelet therapy or lipid-lowering therapy initiation/up-titration. Backwards Wald logistic regression was used to estimate composite endpoint independent predictors.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Results</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">: Of 215 patients, 120 patients underwent ICA (58.6%). Mean age was 67.9±12.0 years; 68.3% male. Hypertension (80.8%) and dyslipidaemia (63.3%) were highly prevalent. HFrEF was present in 44.2% of cases, and 65% had new-onset HF. Chest pain was absent in 82.5% of patients. History of CAD was present in 16.7%. Median left ventricle ejection fraction was 33.78±14.1%. ECG changes suggestive of ischemia were observed in 36.7% of patients,</span></span> <span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">and 35.8% had new-onset segmental kinetic disturbances. CE was more frequent in current smokers (37.5%; p<0.001); absence of previous HF (35.1% vs 12.7%; p<0.001); typical thoracic pain (42.9% vs 16.9%; p=0.016) non-medicated with beta-blockers (24.8% vs 13.3%; p=0.032); new-onset HF (24.5% vs 12.4%; p=0.022); higher haemoglobin (13.5 vs 12.7 g/dL; p=0.039), total cholesterol (169.9 vs 139.5 mg/dL; p<0.001), LDL-C (99.0 vs 74.7 mg/dL; p<0.001) and TG (140.5 vs 109.2 mg/dL; p=0.019); presence of changes suggestive of ischemia (28.4% vs 13.5%; p=0.008) and new-onset segmental kinetic disturbances (42.9% vs 16.9%; p=0.016). When these variables are applied in logistic regression, the resulting module has a very good prediction accuracy for the CE (AUC=0.798 (0.716–0.881)). ECG changes suggestive of ischemia (OR=10.9; p=0.007) and new-onset segmental kinetic disturbances (OR=14.1; p=0.011)</span></span> <span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">were identified as independent predictors of the CE.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">This study highlights the diagnostic and therapeutic importance of simple variables, such as ischemic markers on ECG and echocardiography, in identifying CAD and guiding management in patients with AHF. Elevated cholesterol, smoking, and typical thoracic pain further inform risk of CAD, particularly in new-onset HF cases.</span></span></span></span></p>
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