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The huge impact in left ventricular reverse remodeling of a single drug: A real-world data with ARNI
Session:
Sessão de Comunicações Orais - Insuficiência Cardíaca
Speaker:
Sofia S. Martinho
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sofia S. Martinho; José Almeida; Flávio André Freitas; Valdirene Gonçalves; Catia Ferreira; João André Ferreira; James Milner; Margarida Robalo; Fátima Franco Silva; Susana Costa; Rui Baptista; Lino Gonçalves
Abstract
<p>BACKGROUND: The PROVE-HF study, demonstrated that a reduction in NT-proBNP concentration was correlated with improvements in markers of cardiac volume and function at 12 months, in patients with heart failure with reduce ejection fraction (HFrEF) treated with sacubitril-valsartan. We aimed to assess left ventricular reverse remodeling parameters in a real-world cohort of HFrEF patients treated with ARNI.</p> <p>METHODS: We conducted a single-centre, retrospective, observational study of 140 HFrEF patients treated with the maximum, target dose (97/103 mg bid) of ARNI. Of these, we analysed those (n=52) who had done an echocardiogram at baseline and 6-months after achieving the target dose. Baseline clinical, laboratory and demographic characteristics were evaluated and a clinical and echocardiographic follow-up, including left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS), left ventricular end-systolic volume (LVESV), and diameter (LVESD), left ventricular end-diastolic volume (LVEDV) and diameter (LVEDD), mean E/e′ ratio and mitral valve regurgitation (MR) severity, were conducted from ARNI initiation to a 6-month landmark.</p> <p>RESULTS: Mean age was 60±11 years and 85% were male. At baseline, 58% were on NYHA II and 45% in NYHA III-IV functional class; median NT-proBNP was 660 (IQR 283-1331) pg/dL and mean LVEF 29±8%. Functional class improved significantly, 6 months after target dose, all patients were in NYHA II (56%) or I (44%) (p=0.035). There was a numerical improvement in NT-proBNP, but without statistical significance (p=0.122). Regarding echocardiography, more than half of patients (57.7%) improved LVEF (from 29±8% to 37±10%, mean increase 8.0±9.8%; 95%CI 5.2 to 10.9, p<0.0001). We found a significant improvement in GLS [-1.8±2 (95%CI -2.6 to -0.9%, p<0.001)], a significant decrease in chamber volumes (LVESV, -33±35mL, 95%CI -44mL to -22mL, p<0.0001 and LVEDV, -36±41, 95% CI -49 to -23, p<0.0001) and diameter [LVESD, 6±13mm (95%CI -10 to -2, p=0.003) and LVEDD, 5 ±10mm (95% CI -8 to -2, p=0.001)]. We also identified a significant decrease in E/e’ 3±6 (95%CI -5 to -0.6, p=0.014) and a significant improvement MR severity (p=0.014).</p> <p>CONCLUSIONS: We observed that in an HFrEF patient population treated with ARNI, there was a significant clinical improvement, who may be explained by a robust impact on reverse remodelling, even upon a short follow-up time. A significant improvement in both systolic and diastolic function was found, reinforcing the magnitude of the impact of this drug in a real-world HFrEF population.</p>
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