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Curso de Atualização em Medicina Cardiovascular 2019
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Sexual dysfunction in patients with heart failure: a therapeutic limitation for the patient or the physician?
Session:
Posters 4 - Écran 10 - Insuficiência Cardíaca
Speaker:
Sara Couto Pereira
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Sara Couto Pereira; J. R. Agostinho; Raquel Pires; Fátima Veiga; Joana Rigueira; Inês Aguiar Ricardo; Rafael Santos; Afonso Nunes Ferreira; Pedro Alves Da Silva; Nzinga André; Maria Mónica Mendes Pedro; Fausto José Pinto; Dulce Brito
Abstract
<p><strong>Introduction: </strong>Erectile dysfunction (ED) is a common comorbidity in patients (pts) with cardiovascular disease, with major impact on their quality of life (QoL). Given the association between ED and the pharmacological therapy commonly used in heart failure (HF) with reduced left ventricular ejection fraction (LVEF), the management of ED in these pts may be challenging.</p> <p><strong>Objective</strong>: To evaluate the erectile function (EF) in pts with chronic HF and reduced LVEF, and its possible potential relation with the clinical severity, QoL and pharmacological therapy used to treat the syndrome.</p> <p><strong>Methods</strong>: Single centre prospective study that included men aged 18 to 70 years hospitalized for decompensate chronic HF. EF was assessed at discharge and at 9 ± 3 months of follow-up, using the validated Portuguese Version of the International Index of Erectile Function. ED is considered to be present when the test value is < 26, and can be classified as mild (25-17), moderate (16-11) and severe (10-6). The relationship of EF with clinical features, medical therapy and QoL [(validated Portuguese Version of the Kansas City Cardiomyopathy Questionnaire (KCCQ)]was established by Spearman correlation, Mann-Whitney, Wilcoxon and Chi-square tests.</p> <p><strong>Results</strong>: 24 pts, 62.8 + 7.5 years, were included. The prevalence of hypertension (HTN), diabetes and ischemic heart disease, was 71%, 50%, and 38%, respectively. The median LVEF was 26.5%. The prevalence of ED at the initial evaluation was 92% (mild in 3 pts, moderate in 6 and severe in 13), and 71% at the follow-up (mild in 2 pts, moderate in 3 and severe in 12) – P= N.S. The EF evaluated in the follow-up associated with age (p< 0.01; r= -0.767), HTN (p= 0.30), maximum and minimum NTproBNP values ??recorded during hospitalization (p= 0.11, r= -0.54 and p= 0.38, r= -0.048, respectively), serum creatinine (p= 0.06, r= -0.416) and urea (p= 0.025, r= -0.488).</p> <p>During the follow-up it was possible to increase significantly beta-blocker (p< 0.001) and ACEI/ARB doses (p= 0.006) – compared to pre-admission ones - and a significant improvement in LVEF (p= 0.001) and NYHA functional class (p= 0.002) was also observed. Erectile dysfunction had no relationship with these parameters, but it correlated with physical limitation (p= 0.022, r= 0.509) and frequency of symptoms (p= 0.024, r= 0.502) assessed by KCCQ.</p> <p><strong>Conclusions</strong>: Erectile function in patients with chronic HF correlated with NTproBNP values and erectile dysfunction showed impact on QoL. The progressive increase in doses of neurohormonal antagonists was not associated with a significant change in erectile function, suggesting that the beneficial effects of recommended HFrEF therapies prevail in this population. This should motivate medical therapy uptitration, regardless of the presence of erectile dysfunction.</p>
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