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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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05. Atrial Fibrillation
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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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Marked cardiopulmonary exercise test parameters improvement following sacubitril-valsartan therapy
Session:
CO5 - Insuficiência Cardíaca
Speaker:
António Valentim Gonçalves
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
António Valentim Gonçalves; Tiago Pereira Da Silva; Ana Galrinho; Pedro Rio; Rita Ilhão Moreira; Rui M. Soares; João Pedro Reis; Tânia Branco Mano; Joana Gomes Feliciano; Sofia Silva; Sandra Alves; Eunice Capilé; Madalena Coutinho Cruz; Pedro Modas Daniel; Rui Cruz Ferreira
Abstract
<p><strong>Introduction</strong></p> <p>Sacubitril/Valsartan (LCZ696) had prognosis benefit demonstrated in PARADIGM-HF trial, however less is known about LCZ696 use in a real world Heart Failure (HF) population.</p> <p>The aim of this study is to compare several data before and after LCZ696 therapy, in HF patients.</p> <p> </p> <p><strong>Methods</strong></p> <p>The study was a prospective evaluation of 42 chronic HF patients with optimized standard of care therapy and LV ejection fraction ≤40%, in which LCZ696 therapy was started as it become available in Portugal. The protocol was approved by the hospital ethics committee.</p> <p>Clinical, laboratorial, electrocardiographic and cardiopulmonary exercise test (CPET) data was gathered in the week before starting LCZ696 therapy and 6 months after therapy.</p> <p>The paired samples t-Test was used for the analysis of the variables. Statistical differences with a p value <0.05 were considered significant.</p> <p> </p> <p><strong>Results</strong></p> <p>Of the 42 patients, 35 (83.3%) completed the six-months follow-up with LCZ696, since 2 patients (4.8%) died and 5 patients (11.9%) discontinued treatment for adverse events (2 patients with acute kidney injury and 3 patients with hypotension). No patient was lost during the follow-up. Mean age was 58.6±11.1 years, with 82.9% of male patients and 42.9% with ischemic etiology for HF.</p> <p>Table 1 represents the mean values for some of the data collected before and 6 months after LCZ696 therapy. A significant glomerular filtration rate (GFR) decrease (92.10 VS 83.29ml/min, p=0.005) was noted, however only the 2 patients who had his treatment discontinued had a decrease in the GFR to below 60ml/min.</p> <p>NYHA class was improved by one and two stages in 24 (68.6%) and 2 (5.7%) patients, respectively. 6 patients (17.1%) had a ventricular arrhythmia in the 6 months previous to LCZ696 therapy versus 2 patients (2.7%) during the same LCZ696 therapy period. A significant reduction in the QRS and QTc intervals were noted, as well as a prognostic improvement as assessed by the Heart Failure Survival Score and the MAGGIC score.</p> <p>A marked improvement in peak oxygen consumption (14.35 VS 18.26 ml/kg/min, p<0.001), VE/VCO2 slope (36.67 VS 31.07, p<0.001) and in the duration of exercise were noted with LCZ696 therapy.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>LCZ696 therapy is associated with marked CPET parameters improvement as well as in NYHA class and HF scores. </p> <p>The precise mechanism of LCZ696 to decreases ventricular arrhythmias remains unclear, but a significant reduction in the QTc interval in this patients could have a benefit effect.</p>
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