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Heart failure- one only disease or a group of different entities?
Session:
Posters (Sessão 1 - Écran 4) - Insuficiência Cardíaca 1 - Vários 1
Speaker:
José João Monteiro
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
José João Monteiro; Sara Borges; Pedro Carvalho; Catarina Carvalho; Marta Bernardo; Joaquim Chemba; Fernando Goncalves; Jose Pedro Guimaraes; Helder Ribeiro; Jose Iliido Moreira
Abstract
<p><span style="font-size:12pt"><strong>Introduction</strong></span></p> <p><span style="font-size:12pt"><span style="font-size:11.0pt">Left ventricular ejection fraction (LVEF) recovery is usually associated with better long-term outcomes in heart failure patients (pts). However, the degree of recovery of EF is quite heterogeneous between heart failure etiologies and had different structural features associated.</span></span></p> <p><span style="font-size:12pt"><strong><span style="font-size:11.0pt">Objective</span></strong></span></p> <p><span style="font-size:12pt"><span style="font-size:11.0pt">To study the evolution of structural and clinical features in a cohort of pts with heart failure secondary to different etiologies.</span></span></p> <p><span style="font-size:12pt"><strong><span style="font-size:11.0pt">Methods</span></strong></span></p> <p><span style="font-size:12pt"><span style="font-size:11.0pt">Were included consecutive pts with heart failure diagnosis with reduced LVEF (<40%) and regular follow-up (fup) for at least 12 months in a heart failure unit (n=207, mean fup of 17.83 ± 6.97 months). They were divided in 4 groups, according with heart failure etiology: ischemic (n=70), toxic (n=22), tachicardiomiopathy (n=12), and others (familiar, idiopathic, and hypertensive, n= 103). </span></span></p> <p><span style="font-size:12pt"><span style="font-size:11.0pt">Then, was evaluated the trend of LVEF, End Diastolic Left Ventricle Diameter (EDLVD), and a combined outcome of cardiovascular death, hospital admissions, and urgency department visits secondary to heart failure (MACE), during the fup period and compared them between each group. To characterize these differences was used a One Way ANOVA Test and Qui Square Test to compare baseline differences of the population of each group (see table 1).</span></span></p> <p><span style="font-size:12pt"><strong><span style="font-size:11.0pt">Results </span></strong></span></p> <p><span style="font-size:12pt"><span style="font-size:11.0pt">Pts from ischemic heart failure group had more dyslipidemia (71.4%) than other groups (p=0.027), pts from the group of “other etiologies” had few smokers than other groups, 16.5% (p<0.01), and those from tachycardiomiopathy group had more atrial fibrillation, 83.3% (p< 0.001) (see table 1).</span></span></p> <p><span style="font-size:12pt"><span style="font-size:11.0pt">Pts were under similar heart failure modifying-disease drugs, except mineralocorticoid receptor antagonists, less prevalent in the tachicardiomiopathy group (p<0.001).</span></span></p> <p><span style="font-size:12pt"><span style="font-size:11.0pt">Pts with tachicardiomiopathy showed the higher LVEF recovery, 16.2% ±11.39%, and those from the ischemic group had the slighter increase, 5.24%±9.47, (p=0.014). Use of loop diuretic drugs decreases during fup time, and the magnitude of decrease was higher in tachicardiomiopathy, with no statistically significant differences between groups. EDLVD decreases in all groups, mainly in the toxic heart failure group, although without reaching statistical significance. NYHA Class variation and MACE didn’t achieve significant differences between different groups.</span></span></p> <p><span style="font-size:12pt"><strong><span style="font-size:11.0pt">Discussion</span></strong></span></p> <p><span style="font-size:12pt"><span style="font-size:11.0pt">Our results suggest that tachicardiomiopathy is possibly a more reversible form of heart failure, showing a higher percentage of LVEF recovery during fup time in our heart failure unit. Loop diuretic dose reduction varied in a similar trend, being more pronounced in pts with tachicardiomiopathy, although not reaching statistic significance. In spite of these differences in EF and loop diuretic dose, ventricle reverse remodeling showed a more pronounced trend in the toxic heart failure group. These results highlight the importance of heart failure etiology in the natural history of the disease.</span></span></p>
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