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Left ventricular strain imaging in heart failure patients under sacubitril/valsartan therapy
Session:
Comunicações Orais (Sessão 20) - Insuficiência Cardíaca 3 - Terapêutica Farmacológica
Speaker:
Ana Rita Teixeira
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Rita Teixeira; Pedro Garcia Brás; António Valentim Gonçalves; Luísa Moura Branco; Rita Ilhão Moreira; Tiago Pereira da Silva; Ana Teresa Timóteo; Pedro Rio; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background: Sacubitril/valsartan (SV) is one of the cornerstones of heart failure with reduced ejection fraction (HFrEF) therapy, with results in reversing left ventricular (LV) remodelling. However, data is limited on myocardial LV strain imaging in different HFrEF etiologies in patients (P) under SV therapy. This study aimed to evaluate improvement in LV strain and strain rate parameters with SV therapy in nonischemic and ischemic HFrEF.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Prospective evaluation of HFrEF patients under guideline-directed medical therapy. LV mechanics were assessed by 2D speckle-tracking at baseline and after 6 months of SV therapy. LV longitudinal, radial, and circumferential (circ) strain and respective strain rates were compared and stratified according to nonischemic (group A) and ischemic (group B) etiology. Data analysis was performed with Student’s t-test and Wilcoxon test.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: 35 patients were evaluated (83% male, mean age of 59±11 years). 40% had atrial fibrillation and 43% ischemic etiology. Regarding longitudinal strain, there was a significant improvement in peak longitudinal strain in both groups (A: -5.13 vs -9.66%, p<0.001; B: -6.23 vs -8.81%, p<0.001). There was also an improved systolic strain rate (SRs) (-0.31 vs -0.50s<sup>-1</sup>,p<0.001), early (SRe) (0.24 vs 0.48s<sup>-1</sup>,p=0.001) and late diastolic strain rate (SRa) (0.28 vs 0.45s<sup>-1</sup>,<span style="color:black">p=0.031) in group A, as well as in B: SRs (-0.34 vs -0.44s<sup>-1</sup>,p=0.003), SRe (0.32 vs 0.46s<sup>-1</sup>,p=0.029) and SRa (0.34 vs 0.43s<sup>-1</sup>,p=0.029). </span>Regarding radial strain, both had a significant peak radial strain improvement (A: 6.03 vs 10.37%, p=0.010; B: 5.65 vs 12.2%, p=0.001) and SRe (A: 0.44 vs 0.89 s<sup>-1</sup>, p=0.014; B: 0.67 vs 1.03s<sup>-1</sup>, p=0.031). <span style="color:black">SRs </span>was improved in group A (0.63 vs 0.95s<sup>-1</sup>, p=0.001) but the improvement was nonsignificant in B (0.71 vs 0.83s<sup>-1</sup>, p=0.274). SRa did not show significant difference in both groups. In circ strain, both presented significant improvement of peak circ strain (A: -7.39 vs -9.53%, p=0.036; B: -7.99 vs -10.48%, p=0.008). While there was a significant improvement SRs in group A (-0.64 vs -0.87s<sup>-1</sup>, p=0.021), it was nonsignificant in B (-0.85 vs -0.87s<sup>-1</sup>, p=0.530). SRe and SRa wasn’t significant in both groups.<strong> </strong></span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: After 6 months of SV therapy, there was significant improvement in LV peak longitudinal, radial, circ strain and longitudinal strain rate in nonischemic and ischemic HFrEF P. Radial SRs and circ SRs were significantly improved in nonischemic HFrEF P in contrast to ischemic HFrEF P.</span></span></p>
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