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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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A. Basics
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
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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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Progression of aortic stenosis and myocardial fibrosis: Insights from CT-derived ECV
Session:
Prémio Jovem Investigador
Speaker:
André Filipe Silva Pereira Martins Lobo
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.1 Valvular Heart Disease – Pathophysiology and Mechanisms
Session Type:
Sessão de Prémios
FP Number:
---
Authors:
Andre Lobo; José Cavadas; Carolina Castro; Marta Catarina Almeida; Rafael Teixeira; Fábio Nunes; Mariana Brandão; Pedro Braga; Nuno Dias Ferreira; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Introduction: The rate of aortic stenosis (AS) progression is a major determinant of myocardial damage and adverse clinical outcomes. Sustained pressure overload drives diffuse myocardial fibrosis, which can be quantified non-invasively by computed tomography (CT)- derived extracellular volume (ECV). However, data on ECV changes and AS progression rate are limited. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Methods: Retrospective analysis of patients undergoing cardiac CT for transcatheter aortic valve implantation (TAVI) planning (April 2024 -April 2025). A standardized 5-minute delayed dual-energy acquisition was used for ECV quantification. AS progression was evaluated in patients with classical high-gradient severe AS and at least two echocardiographic examinations separated by ≥6 months. AS progression was defined as the annualized change in aortic stenosis maximum velocity (ΔVmax/year). Rapid progression was defined as ΔVmax > 0.30 m/s/year. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Results: Among 253 patients with available ECV quantification, 126 fulfilled criteria for AS progression analysis. The median AS progression rate was 0.29 m/s/year. AS progression rate showed a significant positive association with ECV (Spearman ρ = 0.485, p < 0.001). In multivariable linear regression, ΔVmax/year remained independently associated with ECV after adjustment for clinical and echocardiographic covariates (p < 0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">When stratified by ECV quartiles, a marked stepwise increase in AS progression was observed, with median ΔVmax/year rising from 0.12 m/s/year in the lowest quartile to 0.64 m/s/year in the highest quartile (p < 0.001). After categorizing patients as rapid (ΔVmax > 0.30 m/s/year) or slow progressors, ECV remained independently associated with rapid AS progression (OR 1.234, 95% 1.11–1.37, p < 0.001)</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Conclusion: Higher rates of AS progression are independently associated with greater myocardial damage assessed by cardiac CT, supporting accelerated pressure overload as a principal driver of diffuse myocardial fibrosis. CT-derived ECV identifies patients with rapid hemodynamic disease progression and may represent an integrative marker of cumulative myocardial injury with potential implications for surveillance and timing of intervention.</span></span></p>
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