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CPC 2019
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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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
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0 Themes
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
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
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
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Real-world experience with ARNI: reverse remodelling is the norm
Session:
Posters 2 - Écran 7 - Insuficiência Cardíaca
Speaker:
Sofia S. Martinho
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:
Sofia S. Martinho; J Almeida; R Baptista; Fátima Franco Silva; M Robalo; Ana Pinho; L Gonçalves
Abstract
<p>BACKGROUNG: The randomized clinical trial PARADIGM-HF proved that compared with enalapril, Angiotensin II Receptor Blocker Neprilysin Inhibitor (ARNI), sacubitril-valsartan, reduced the risk of hospitalization for heart failure (HF) by 21%, decreased cardiovascular (CV) and all cause of death and reduced the symptoms and physical limitations of heart failure, in patients with reduced left ventricular ejection fraction (LVEF). In Portugal, this drug has only 1-year approval. We considered that analysing the application and performance of this drug in our Portuguese population was fundamental, through a real-word study.</p> <p>METHODS: We conducted a retrospective, observational study of 200 patients with HF treated with sacubitril-valsartan, in a single-centre. Patients were selected whether they were at 97/103mg dose, twice a day (b.i.d) (n=100). Then primary co-endpoints were: improvement of LVEF, New YorK Heart Association functional class (NYHA) and N-terminal pro B-type natriuretic peptide (NT-proBNP) from baseline (start ARNI) until 3 months after initiating 97/103mg (b.i.d) dose. We also analysed events after tolerating the studied dose: CV Death, HF first hospitalization, emergency visits for Acute HF (AHF), <em>de novo</em> atrial fibrillation (AF) and appropriate defibrillator shocks. Baseline clinical and demographic characteristics were evaluated, as well as the time until maximum dose was reached.</p> <p>RESULTS: In our cohort, mean age was 59 ±12.6, and 86% were male. 51.5% of patients had HF of non-ischemic etiology. Median time between initiation of the drug and reaching the 97/103mg dose was 11 weeks. Regarding our primary endpoints: LVFE improved on average 3.7% ±8.9, with statistical significance (95% IC 1.641 to 5.924; p=0.001). This was verified in 46% (n=32) of the subpopulation studied and in 16.7% of these, LVFEF increased to >35%. NT-proBNP had a mild mean increase of 15.7pg/mL, but without statistical significance; NYHA functional class had a significant improvement (IC 95% 0.008-0.012; p=0.005), 47% of patients with baseline NYHA II changed to I; 81% III to II and 66% IV to II. After 3 months on the 97/103mg b.i.d dose, CV Death occurred in 1%, <em>de novo </em>AF in <em>1</em>%, first HF hospitalization in 2%, appropriate ICD shock in 3% and emergency visits for AHF in 9%.</p> <p>CONCLUSIONS: as we expect there was a significant improvement in LVEF and symptoms of HF with this drug. Similarly to previous studies, 16.7% improve LVEF above 35%, and no longer have guideline-derived indication for prophylactic implantable cardioverter defibrillator.</p>
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