SPC365

Optimized medical therapy in non-ischemic heart failure – How about real life?

Session: Posters - D. Heart Failure
Speaker: Alexandra Briosa

Congress: CPC 2021
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Posters
FP Number: ---
Authors: Alexandra Briosa; Otilia Simoes; Sofia Alegria; Ana Rita Almeida; Ana Rita Pereira; Joao Santos; Barbara Ferreira; Mariana Martinho; Rita Miranda; Hélder Pereira
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Introduction:</span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> In the last recent years, the world has faced a constant innovation with regard to treatment of heart failure with reduced ejection fraction (HFREF). New pharmacological classes, such as angiotensin receptor- neprilysin inhibitor (ARNI) or SGLT2-inhibitors, had shown impressive results in clinical trials. However, little real-life data is available regarding the improvement on left ventricle ejection fraction (LVEF) in pts medicated with ACE inhibitors and betablockers (BB). &nbsp;</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Aim: </span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">To characterize patients (pts) with non-ischemic dilated cardiomyopathy that were admitted to our heart failure consultation in the last 2 years. To define how many started therapy with ACEi and BB in the first place and which was the impact on the LVEF after reaching the optimized dose. </span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods: </span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Single center retrospective study that analyzed all pts with non-ischemic dilated cardiomyopathy admitted on<strong> </strong>heart failure appointments in the last two years (2018-2020). Clinical and imaging data were collected, as well as data concerning treatment options and target doses. After optimized medical therapy, echocardiographic evaluations were performed in order to evaluate LVEF improvement. The primary endpoint was a composite endpoint of final LVEF &gt; 40% and NT-proBNP &lt; 300 pg/mL.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Results: </span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">We analyze a total of 64 pts with non-ischemic dilated cardiomyopathy, 71,9% from the male sex, with a mean age of 59&plusmn;12 years old. Concerning cardiovascular risk factors: 46,9% had hypertension, 34,4% dyslipidemia, 28,1% were active smokers or had at least moderate beverage habits and 20,3% had diabetes. 31,7% had history of atrial fibrillation and 15,6% were obese. The initial median LVEF was 28%, half of the pts had at least moderate mitral regurgitation and 45% had also right ventricle dysfunction. </span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">By the time of first evaluation, the majority were in NYAH class 2 or higher. The mean systolic blood pressure was 106&plusmn;18 mmHg, mean NT-proBNP level was 3096&plusmn;5138 pg/mL and mean creatine level was 1,1&plusmn;0,46 mg/dL.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Regarding medical therapy, 61,1% of the pts started combined therapy with ACE-I and BB. The mean percentage of maximum dose achieved for ACEi and for BB therapy was 69&plusmn;30% and 72&plusmn;28%. 16% were medicated with SGLT2i. Three to six months after optimized medical therapy with ACE-i+BB, there was a significant improvement in LVEF (42 vs 27%, p&lt;0.001) and on NT-proBNP levels (769 vs 2771 pg/mL, p&lt;0.001). More than a half of pts (58,75) achived the primary combined endpoint after 6 months, 2 pts were hospitalized due to heart failure and 1 died. </span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusions: </span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Treatment of HRREF is facing a constant innovation nowadays.<strong> </strong>On this real-life study, a significant proportion of pts non-ischemic dilated myocardiopathy medicated with ACE-I and betablocker&nbsp;showed important improvement on final LVEF and NT-proBNP levels after 6 months of optimized treatment.</span></span></span></span></span></p>