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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Antiarrhythmic effect of Sacubitril-Valsartan: cause or consequence of clinical improvement?
Session:
Sessão de Comunicações Orais - Insuficiência Cardíaca
Speaker:
António Valentim Gonçalves
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.1 Chronic Heart Failure – Pathophysiology and Mechanisms
Session Type:
Comunicações Orais
FP Number:
---
Authors:
António Valentim Gonçalves; Tiago Pereira Da Silva; Ana Galrinho; Isabel Gonçalves Machado Cardoso; André Grazina; Luisa Moura Branco; Pedro Rio; Ana Teresa Timóteo; João Pedro Reis; Rui M. Soares; Joana Gomes Feliciano; Rita Ilhão Moreira; Tiago Mendonça; Tânia Branco Mano; Rui Cruz Ferreira
Abstract
<p><strong>Introduction</strong></p> <p>Sacubitril/Valsartan significantly reduced sudden cardiac death in the PARADIGM-HF trial. However, there is little published data regarding the possible explanations for the antiarrhythmic effects found with Sacubitril-Valsartan therapy.</p> <p>Previous trials have shown that mechanical dispersion by strain echocardiography can predict arrhythmic events in Heart Failure (HF) patients.</p> <p>The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index with left ventricular (LV) global longitudinal strain (GLS) analysis before and after Sacubitril-Valsartan therapy.</p> <p> </p> <p><strong>Methods </strong></p> <p>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 additional HF treatment was expected to change.</p> <p>ECG and transthoracic echocardiographic data were gathered in the week before starting Sacubitril-Valsartan therapy and 6 months after therapy. A semiautomated analysis of LV GLS was made and mechanical dispersion index was defined as the standard deviation from the 16 time intervals corresponding to each LV segment.</p> <p> </p> <p><strong>Results</strong></p> <p>Of the 42 patients, 35 (83%) completed the 6 months of follow-up, since 2 (5%) patients died and 5 (12%) discontinued treatment for adverse events. Mean age was 59 ± 11 years.</p> <p>During the 6 months of follow-up, there was no change in the heart rate (72 ± 13 vs 67 ± 12, p=0.067) or in the beta-blockers dose as assessed by per cent of target dose (69 ± 29% vs 71 ± 28%, p=0.278).</p> <p>QTc interval (452 vs 426msec, p<0.001) and QRS interval (125 vs 121msec, p=0.033) were reduced after 6 months of Sacubitril-Valsartan therapy. Mechanical dispersion index (88 vs 78msec, p=0.036) was also significantly reduced after therapy. Figure 1 shows an example of mechanical dispersion index reduction.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>Sacubitril-Valsartan has been linked with an antiarrhythmic effect not fully understood. To the best of our knowledge, this was the first prospective study evaluating the ECG changes and the impact of LCZ696 on mechanical dispersion index, with a significant reduction in QTc, QRS intervals and mechanical dispersion index.</p>
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