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Myocardial Work improvement after Sacubitril-Valsartan: a new parameter for a new treatment
Session:
Sessão de Comunicações Orais - Imagem
Speaker:
André Grazina
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
André Grazina; António Valentim Gonçalves; Ana Galrinho; Tiago Pereira Da Silva; Luisa Moura Branco; Pedro Rio; Ana Teresa Timóteo; Joao Abreu; Rui M. Soares; Rita Ilhão Moreira; Isabel Gonçalves Machado Cardoso; Rui Cruz Ferreira
Abstract
<p><strong>Introduction:</strong> Myocardial work (MW) is a new transthoracic echocardiographic (TTE) parameter that enhances the information provided through left ventricular (LV) global longitudinal strain (GLS). Nothing is known about the impact of Sacubitril/Valsartan therapy on MW parameters.</p> <p><strong>Purpose:</strong> This study aims to evaluate the effects of Sacubitril/Valsartan on LV MW in Heart Failure (HF) patients.</p> <p><strong>Methods:</strong> Prospective evaluation of chronic HF patients with LV ejection fraction ≤40% despite optimized standard of care therapy for at least 6 months, in which Sacubitril-Valsartan therapy was started and no other HF treatment was expected to change. TTE study was performed before and six months after Sacubitril-Valsartan therapy. A semiautomated analysis of LV GLS was performed after two-dimensional images were acquired in the standard apical four-, three- and two-chamber views. Valvular timings obtained from TTE and the instantaneous systolic pressure value estimated by a brachial artery cuff were used to estimate a normalized, patient specific LV pressure curve. After that, MW was estimated using custom software of GE Vivid E95 ultrasound system. The paired samples t-Test was used for the analysis of the variables. Statistical differences with a p value <0.05 were considered significant.</p> <p><strong>Results:</strong> Of the 42 patients, 35 (83.3%) completed the six-months follow-up with Sacubitril-Valsartan, since 2 patients (4.8%) died and 5 patients (11.9%) discontinued treatment for adverse events. No patient was lost during the follow-up. Mean age was 58.6 ± 11.1 years, with 82.9% of male patients and 42.9% with ischemic etiology for HF. Table 1 represents the mean values for TTE parameters before and 6 months after Sacubitril-Valsartan therapy. TTE data showed a significant reduction in LV dimensions and atrial volumes, as well as an improvement in LV ejection fraction (29.3% vs 35.2%, p=0.001) and GLS (-7.0% vs -8.9%, p=0.001). MW had a significant increase in global constructive work (720.2mmHg% vs 900.6mmHg%, p=0.016) and global work efficiency (78.6% vs 86.6%, p=0.027), with a non-significant decrease in global wasted work (150.2mmHg% vs 136.8mmHg%, p=0.441) at six months.</p> <p><strong>Conclusion:</strong> Sacubitril-Valsartan was associated with signs of reverse remodelling by usual TTE. MW seems to be a new tool providing information for the comprehension of the reverse remodelling mechanism, as revealed by an increase in constructive work and work efficiency with Sacubitril-Valsartan therapy. </p>
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