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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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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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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
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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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Impact of sacubitril-valsartan on clinical-laboratorial parameters, left ventricule ejection fraction and loop diuretic doses of patients with chronic heart failure. Brazil and Portugal experience.
Session:
Painel 2 - Insuficiencia Cardiaca 6
Speaker:
Ricardo Mourilhe Rocha
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:
Ricardo Mourilhe Rocha; Fernanda Costa Ferreira; Marta Afonso Nogueira; Carla Matias; Ines Nabais; Elia Baptista; Gonçalo Miranda Proença; Pedro Pimenta de Mello Spineti; Marcelo Imbroinise Bittencourt; Felipe Neves de Albuquerque; Ana Luiza Ferreira Sales; Denilson Campos de Albuquerque
Abstract
<p>Background: Sacubitril-Valsartan (SacVal) was approved to treat heart failure (HF) in Brazil and in Portugal in 2017. Experience with this drug in our countries is still limited. The particularities of the management of these patients (pts) and the interaction with other drugs are also unprecedented for most cardiologists. It’s important to report our experience regarding safety and efficacy of this drug. Objectives: To observe the effect of SacVal on clinical, therapeutic, left ventricule ejection fraction (LVEF) on echocardiogram, hemodynamic and laboratorial parameters of two different outpatients’ populations with HF with reduced ejection fraction (HFrEF) followed-up in Brazil and Portugal. Methods: Observational study of two HFrEF outpatient cohorts. From August 2017 to January 2019, 122 patients with optimal drug therapy were switched from Angiotensin-Converting Enzyme Inhibitor/Angiotensin Receptor Blocker (ACEI-ARB) to SacVal. Pts were reassessed during the follow-up period according to countries protocols. The titration of SacVal respected the clinical-hemodynamic response and individual laboratory parameters. Results: The median follow-up time was 231 [133,8-323] days, 72.3% male, median age=69 [58-79] years, 50.9% with ischemic etiology, 63.5% hypertension, 30.4% diabetes, 16.7% COPD, 45.2% dyslipidemia, 22.8% anemia and 34.8% permanent atrial fibrillation. Considering ESC guideline for HF therapy, 97.3% were using betablockers, 93.1% ACEI-ARB, 67.9% mineralocorticoid receptor antagonist, 80.5% loop diuretics, 19.5% ivabradine, 9.6% CRT and 14.1% ICD. The median SacVal daily dose was 200 [100-400]mg. Regarding laboratory parameters post SacVal, the median creatinine was 1.1 mg/dl, potassium 4.7mEq/L and hemoglobin 13.5 mg/dl. When we compare data BEFORE and AFTER SacVal, respectively: the median blood pressure (BP) was 117x70mmHg and 115x70mmHg (p=0.105); median heart rate (HR) 70bpm and 64 bpm (p=0.007); LVEF=30 [25-34]% and 35 [30-40]% (p<0,001); median NTproBNP 3123 [1386-5204] and 1872 [643-3542]pg/ml (p=0.007). At the start of SacVal, 5.9% were in NYHA class I, 46.6% in class II, 44.1% in class III and 3.4% in class IV, and after SacVal, 33% were in class I, 53.6% in class II, 10.7% in class III and 2.7% in class IV (p<0.001). A significant therapeutic finding was a marked reduction in furosemide use pre-SacVal versus post SacVal (80.5% x 66.4%, p=0,016) and 48% of pts reduced loop diuretic. During follow-up, we noticed 10.6% of hospitalizations, 2.5% of deaths and SacVal discontinuation in 6.7% of pts. Conclusion: in a cohort with a high severity profile, we observed a good tolerance of SacVal, associated to a low rate of adverse events during follow-up. In addition, we noted the relevant impact in reducing loop diuretic doses needed to compensate HF, as well as LVEF improvement and NTproBNP reduction that may be related to remodeling benefit of the drug.</p> <p> </p>
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