Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
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
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
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
O. Basic Science
P. Other
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
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Who ARNI the best responders among patients with LVEF<35%?
Session:
Posters 3 - Écran 10 - Insuficiência Cardíaca
Speaker:
José Lopes De Almeida
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:
José Lopes De Almeida; S Martinho; R Baptista; Fátima Franco Silva; S Costa; M Ferreira; M Robalo; L Gonçalves
Abstract
<p><strong>Introduction: </strong>Although it is not a perfect surrogate in heart failure (HF), left ventricle ejection fraction (LVEF) is an important tool to guide therapy and evaluate ventricular function. The cutoff of 35% is of particular interest because it is helpful in guiding therapeutic decisions, pharmacological and device-related. Among patients on Angiotensin II Receptor Blocker Neprilysin Inhibitor (ARNI) with LVEF below this threshold, we wanted to identify which factors could help us predict a more favorable response to this therapy.</p> <p><strong>Methods: </strong>We retrospectively studied a population of 200 HF patients treated with ARNI. We selected patients with LVEF (evaluated with nuclear imaging) <35% and on maximum ARNI dose (n=78) and divided them into 2 groups: those who reached an EF>35% after at least 3 months of ARNI titrated up to maximum dose (optimal responders, n=14) and those who did not reach this threshold (“non-responders”, n=64). There were no deaths. We characterized our population and looked for significant differences betweeb groups.</p> <p><strong>Results: </strong>Our population had a mean age of 60.5 ± 11.9, baseline LVEF 24.9 ± 5.6%, medium blood pressure of 126.2 ± 16.2mmHg, creatinine 1.12 ± 0.38mg/dL, K of 4.55 ± 4.49mmol/L and NT-proBNP 128105 ± 1476.2pg/mL. 90.8% of patients were men and 55.1% had an ischemic etiology. Regarding symptoms, 56% were in NYHA Class II, 60% in NYHA Class III and 4% in NYHA class IV. The majority of patients had an implanted ICD (36.8%) or CRT-D (39.5%). Considering comorbidities, 40% of patients had diabetes, 38.7% AF and 30% had smoking habits. For previous events, 41.3% had a previous acute coronary syndrome and 65.8% a previous HF hospitalization. 98.7% of patients were on beta-blocker (30.7% reached maximum dose), 98.7% on angiotensin inhibitor (32% on maximum dose), 66.7% had aldosterone inhibitor on intermediate to high dose. 96% had furosemide.</p> <p>There was a statistically lower rate of ischemic vs non-ischemic patients within the responder group (12.9% vs 28.5%, p=0.026) than within the non-responders (87.1% vs 61.5%, p=0.026) and a trend towards lesser rate of previous ACS (12.5% vs 34.4%, p=0.061) comparing to non-responsders (87.5% vs 65.6%, p=0.061). Within ischemic patients, only 12.9% of patients reached EF>35%, compared with 38.5% of non-ischemic (RR=2.95, p=0.026). No other factors were statistically different between compared groups.</p> <p><strong>Conclusions: </strong>We observed that ischemic HF patients have an overall worse response to neuro-hormonal system modulator therapy, and this is in line with previous reports. The same remains true for this particular subset of patients, who already carry a poor prognosis and may benefit from other therapies, medical or structural. On the other hand, non-ischemic HF patients appear to be better responders and the expected favorable outcome could be helpful to better optimize the adequacy and timing of other therapies.</p> <p> </p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site