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Curso de Atualização em Medicina Cardiovascular 2019
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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Angiotensin receptor-neprilysin inhibition improves peak oxygen consumption in reduced heart failure
Session:
Posters 1 - Écran 9 - Insuficiência Cardíaca
Speaker:
Cátia Santos Ferreira
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Cátia Santos Ferreira; Sofia S. Martinho; J Almeida; Célia Domingues; André Azul Freitas; James Milner; Rui Baptista; Susana Costa; Fátima Franco Silva; Henrique Vieira; Rosa Coutinho; Lino Gonçalves
Abstract
<p>PURPOSE:The addition of Angiotensin Receptor-Neprilysin Inhibitors (ARNI) to standard therapy of heart failure with reduced ejection fraction (HFrEF) has proved to improve outcomes. Cardiopulmonary exercise testing (CPET)-derived ergometric variables, as peak oxygen consumption (VO<sub>2</sub>), are used to determine heart transplant (HTx) eligibility. We aimed to analyse the impact of ARNI therapy in CPET variables.</p> <p>METHODS: We conducted a retrospective, observational cohort study, including 19 patients with symptomatic HFrEF with a left ventricular (LV) ejection fraction (LVEF) <35% and whose functional capacity was evaluated by CPET less than 6 months before initiating ARNI. We excluded patients who had implanted a cardiac resynchronization therapy device (CRT) or were submitted to heart surgery less than 6 months before the first CPET. A follow-up CPET was conducted 7±4 months after starting ARNI. </p> <p>RESULTS: Mean age was 55±12 years and 90% were male. Mean LVEF was 26±6% and before initiating ARNI, all patients were on optimal medical therapy, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (100%), ß-blockers (94.7%) and mineralocorticoid receptor antagonists (89.5%). Moreover, 9 patients had an implantable cardioverter defibrillator (D) and 9 patients had a CRT-D.Regarding aetiology, 11 had ischemic heart disease, 6 had dilated cardiomyopathy, 1 had corrected transposition of great arteries and 1 had LV non-compaction. The majority of the patients (73.7%) were on maximal doses of ARNI (97/103mg bid); the remaining were on intermediate dose (49/51 bid). Following ARNI, peak VO<sub>2 </sub>significantly increased from 15.4±5.2 to 17.0±4.0 mL.kg<sup>-1</sup>.min<sup>-1</sup>(mean absolute increase of +1.5 mL.kg<sup>-1</sup>.min<sup>-1</sup>, p=0.03). Among the 7 patients with peak VO<sub>2</sub><14 mL.kg<sup>-1</sup>.min<sup>-1</sup>, 3 (43%) improved peak VO<sub>2 </sub>to values >14 mL.kg<sup>-1</sup>.min<sup>-1</sup>, pulling the patients out of one of the classical HTx eligibility markers. Regarding other ergometric variables, a numerically increase was observed in mean total exercise duration (12:45 to 13:27 min), in respiratory exchange ratio (RER) (1.08±0.11 to 1.12±0.08) and in peak oxygen pulse (9.9±2.7 to 10.6±2.6 mL.beat<sup>-1</sup>). Conversely, the mean respiratory efficiency index (VE/VCO<sub>2</sub>) following ARNI remained similar. </p> <p>CONCLUSION: In this cohort of HFrEF patients, ARNI significantly improved peak VO<sub>2</sub>, a major prognostic predictor. Importantly, 3 out of 7 patients with a peak VO<sub>2 </sub>within the HTx threshold recovered to ineligibility values.</p>
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