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Left atrial mechanics improvement after initiation of sacubitril-valsartan
Session:
Painel 3 - Imagiologia Cardiovascular 4
Speaker:
Marta Sofia Ferreira Fonseca
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Marta Ferreira Fonseca; José Maria Farinha; Sara Gonçalves; Rita Marinheiro; Ana Fátima Esteves; Antonio Pinheiro Cumena Candjondjo; Joana Silva Ferreira; Rui Caria
Abstract
<p><strong>Introduction: </strong>Heart failure with reduced ejection fraction (HFrEF) is traditionally associated with significant morbidity and mortality. Recently, new drugs have been introduced in the management of chronic HFrEF. In the PARADIGM-HF sacubitril-valsartan was superior to enalapril in reducing death and hospitalization for heart failure, and there is a growing interest in determining the structural changes besides reverse left ventricular (LV) remodelling.</p> <p><strong>Purpose: </strong>To determine if, in patients treated with sacubitril-valsartan, there was a change in left atrial (LA) mechanics quantified by two-dimensional strain echocardiography (2D-STE).</p> <p><strong>Methods: </strong>A total of 38 consecutive patients with HFrEF, followed in an outpatient heart failure clinic, were recruited. The population was characterized concerning clinical data, previous medical history, guideline-directed therapy and baseline laboratory results (Table 1). 2D-STE was used to measure left atrial strain in the reservoir phase (LASr) (Figure 1) and strain rate (LA-SR) before and 3 months after initiation of sacubitril-valsartan. Conventional echocardiographic LA and LV measurements were also determined.</p> <p><strong>Results: </strong>There was a significant improvement in LASr (11.3 ± 6.5% vs 14.2 ± 7.4%, p=0.006) and LA-SR (0.55 ± 0.25 s<sup>-1</sup> vs 0.69 ± 0.31 s<sup>-1</sup>, p=0.008) after initiation of sacubitril-valsartan. There was also a significant reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (1443.5 pg/ml (Interquartile range [IQR], 772-2912) vs 1112.0 pg/ml (IQR, 510-1455), p=0.016) and a tendency towards reduction in left atrial volume index (LAVI) (54.6 ± 17.0 ml/m<sup>2</sup> vs 51.4 ± 18.8 ml/m<sup>2</sup>, p=0.053). Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-sistolic volume index (LVESVI) and ejection fraction (EF) were numerically better although without reaching statistical significance (100.3 ± 32.7 ml/m<sup>2 </sup>vs 94.1 ± 34.3 ml/m<sup>2</sup>, p=0.071; 68.0 ± 25.0 ml/m<sup>2</sup> vs 63.4 ± 26.4 ml/m<sup>2</sup>, p=0.086; 32.4 ± 7.7% vs 34.7 ± 8.3%, p=0.100; respectively). At the moment of echocardiographic re-evaluation, 2 patients (5.3%) had the lower dose of sacubitril-valsartan, 16 patients (42.1%) the intermediate dose and 20 patients (52.6%) the higher dose. The change in LASr and LA-SR was not related with the dose of sacubitril-valsartan (p=0.089).</p> <p><strong>Conclusion: </strong>In this population of HFrEF patients LA mechanics, as determined by 2D-STE, as well as NT-proBNP levels, significantly improved after treatment with sacubitril-valsartan.</p>
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