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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
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
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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
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
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
36. Basic Science
37. Miscellanea
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Effect of Sacubitril/Valsartan on Ventricular Arrhythmia Burden in Heart Failure with Reduced Ejection Fraction
Session:
Posters (Sessão 5 - Écran 2) - Arritmias 5 - Foco na Insuficiência Cardíaca
Speaker:
Paulo Medeiros
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Paulo Medeiros; Cláudia Coelho; Cátia Oliveira; Sérgia Rocha
Abstract
<p style="text-align:justify">Introduction: Sacubitril/Valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI) is currently one the first-line drugs for prognosis improvement in heart failure with reduced ejection fraction (HFrEF). Antiarrhythmic properties of Sacubitril/Valsartan have been suggested. However, limited and conflicting evidence existed regarding this topic.</p> <p style="text-align:justify">Aims: To evaluate the effect of Sacubitril/Valsartan on the incidence of ventricular arrhythmias in HFrEF patients.</p> <p style="text-align:justify">Methods: Single-centre, observational and retrospective study. Inclusion criteria: left ventricle ejection fraction (LVEF)≤40%; NYHA class ≥II, optimal medical therapy (excluding ARNI) for at least 12 months with subsequent ACEi/ARB replacement with ARNI; carriers of implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT). Exclusion criteria were NYHA class IV and implantation of ICD/CRT after the introduction of ARNI. Primary outcome was ventricular arrhythmic burden (including appropriate shocks, sustained ventricular tachycardia (VT) and ventricular fibrillation (VF)) pre and post ARNI. Secondary outcomes included change in NYHA class, NT-proBNP, LV end diastolic diameter (LVEDD) and LVEF. Data on arrhythmic episodes was obtained from device interrogation.</p> <p style="text-align:justify">Results: Fifty-four patients met the inclusion criteria. Mean age was 69.5 years and 74% (n= 40) were male. HFrEF had ischemic aetiology in 59%. All the patients were on ACEi/ARB and beta-blockers, 94% on stable doses of diuretics and 72% on mineralocorticoid receptor antagonist. Comparison of the 12 months prior to the 12 months after Sacubitril/Valsartan initiation:<br /> The number of patients experiencing appropriate shocks was significantly lower after ARNI initiation (2% vs. 18%; p=0.016). The total number of VT and VF episodes was lower after the initiation of the drug, but this difference was not statistically significant (4% vs. 13% for VF; p=0.289; 13 vs. 20% for VT; p=0.549). NYHA class significantly improved after initiation of Sacubitril/Valsartan (pre ARNI: class I 0%; class II 77%; class III 23%; post ARNI: class I 14%; class II 80%; class III 6%; p = 0,001). However, no significant differences were observed in LVEF (mean 30% vs. 28%; p=0.315), LVEDD (mean 66 vs. 65 mm; p=0.549) or NT-proBNP (mean 775 vs. 1128 pg/mL; p=0.858).</p> <p style="text-align:justify">Conclusions: Sacubitril/Valsartan seems to reduce the risk of arrhythmic events requiring appropriate shock therapy (even without a significant change in echocardiographic LV remodelling parameters). The sample size is an important limitation of this study. Prospective and larger studies are needed to better address this question.</p>
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