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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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A. Basics
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C. Arrhythmias and Device Therapy
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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
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15. Valvular Heart Disease
16. Infective Endocarditis
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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
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Empagliflozin- effects in heart and vessels
Session:
Posters 4 - Écran 7 - Prevenção
Speaker:
Brenda Moura
Congress:
CPC 2019
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.7 Diabetes and the Heart
Session Type:
Posters
FP Number:
---
Authors:
Brenda Moura; Emília Moreira; Leonilde Coelho; Paulo Dias
Abstract
<p><strong>Background</strong>: In the EMPA-REG Outcome trial, empagliflozin (EMPA) reduced the 3P-MACE (CV death, non-fatal MI or non-fatal stroke) and hospitalizations for heart failure. Cardiac evaluation was not performed, so the underlying mechanisms are not known.</p> <p><strong>Aim</strong>: To analyze the impact of EMPA in cardiac and vascular function in patients with diabetes mellitus (DM).</p> <p><strong>Methods</strong>: We prospectively included patients with DM before starting medication with EMPA between June 2017 and May 2018. Other Inclusion criteria were stable anti-diabetic and cardiovascular therapy in the last 3 months, eGRF>60 ml/min/m<sup>2</sup>; exclusion criteria were acute coronary syndrome, heart failure or sepsis in the last 6 months. Patients had a visit before and 6 months after starting EMPA, and anthropometric measures, blood analysis, Echocardiogram, and measure of Pulse Wave Velocity (PWV) were performed. Baseline and follow-up data were compared using paired sample t-test.</p> <p><strong>Results</strong>: 38 patients were evaluated, only 23 completed follow-up. Mean follow-up length was 7 months. Mean age 65±7 (47-80) years, 70% males. At baseline, BMI was 31.4±4.3 Kg/m<sup>2</sup>, hemoglobin was 14.0±1.2 gr/dL, and 59% of patients had hgbA1c =7%. Only 8% were treated for cardiac disease.</p> <p>At baseline, 52% pts had left atrium (LA) area > 20 cm<sup>2 </sup> ( <sup>-</sup>21.6 ± 3.8 cm<sup>2</sup>), 57% had left atrium volume index (LAVI) > 34 ml/m<sup>2</sup> ( 35.0 ± 9.7 mL/m<sup>2</sup>), E/e´ was >8 in 71%. Left ventricular mass index (LVMI) was 108.2 gr/m<sup>2</sup> in men and 111.6 gr/m<sup>2 </sup>in women. GLS was <- 20 in 85% of patients (mean value -17.3 ± 3.4). No other echocardiographic abnormalities were found.</p> <p>At the end of follow-up, BMI decreased (31.4 vs 30.4 Kg/m<sup>2</sup>; p=0.04) and hemoglobin values increased (14.0 vs 14.8 gr/dL, p<0.001).</p> <p>There was a significant reduction in LA area (21.6 to 20.3 cm<sup>2</sup>, p=0.036), LAVI (35.0 to 31.7mL/m<sup>2</sup> p=0.044) and also in right atrial volume index (21.0 to 18.6 mL/m<sup>2</sup>, p=0.048). E/e´ decreased (12.1 vs 11.0; p=0.029), but only in those with E/e´ = 8 at baseline.</p> <p>Additionally PWV showed a significantly reduction – from 9.5 to 8.0 m/s (p=0.006).</p> <p><strong>Conclusion</strong>: In most of our DM patients, Echocardiographic evaluation showed diastolic dysfunction, and abnormal left ventricular Global Longitudinal Strain value. Treatment with EMPA decreased atria volume, suggesting ventricular unloading. PWV, an important metric of vascular health, was also significantly improved.</p> <p> </p>
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