SPC365

The effects of Sacubitril-Valsartan on ICD indication in patients with heart failure

Session: Posters (Sessão 5 - Écran 2) - Arritmias 5 - Foco na Insuficiência Cardíaca
Speaker: MARIANA GOMES TINOCO

Congress: CPC 2022
Topic: C. Arrhythmias and Device Therapy
Theme: 08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme: 09.2 Implantable Cardioverter / Defibrillator
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Mariana Tinoco; Ana Filipa Cardoso; Geraldo Dias; Tamara Pereira; Bebiana Faria; Filipa Almeida; Sérgio Leite; António Lourenço
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Background</span></span></span></span></strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">The use of an implantable cardioverter-defibrillator (ICD) to avoid sudden cardiac death is indicated in patients with symptomatic heart failure (HF) and LVEF &le;35% after &ge;3 months of optimal medical therapy (OMT). Sacubitril-Valsartan (SV) has showed to reduce morbidity and mortality compared to ACEI, due to positive effects on cardiac remodelling.&nbsp;</span></span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Purpose</span></span></span></span></strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">We sought to assess the impact of SV on ICD indication in patients with HF with reduced ejection fraction (HFrEF).</span></span></span></span><br />
<br />
<strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Methods</span></span></span></span></strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Retrospective study of patients with HFrEF and a previously implanted ICD who started therapy with SV on top of OMT, observed at an HF clinic between Jan 2018 and Jun 2020, with a follow up period until Oct 2021. Patients treated with SV pre-implantation were excluded. </span></span></span></span></span></span></p>

<p><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Results</span></span></span></span></strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">A total of&nbsp;28 ICD carriers were included: 65,7&plusmn;8,7 years; 24 (85,7%) male; mean LVEF at baseline 26,8&plusmn;7,3%; </span></span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Over a median follow-up of&nbsp;9 [5-22] months, SV induced a significant decrease in LV end-diastolic volume index (169 mL/m<sup>2</sup> vs 93 mL/m<sup>2</sup>; p=0,003) and in LV end-systolic volume index (124 mL/m<sup>2</sup> vs 65 mL/m<sup>2</sup>; p=0,001), nonetheless it resulted in a non-significant increase in LVEF (28,5% vs 32,3%). In 21,6% (6) of patients previously implanted with an ICD, LVEF improved to &gt; 35% at follow-up, therefore they did not meet anymore eligibility criteria. At follow up: 8 (28,6%) were in NYHA class I, of which 50% achieved a LVEF &gt; 35%; The remaining 18 (64,2%) were in NYHA class II-III and 2 (7,1%) were in NYHA class IV.</span></span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Among patients deemed not more eligible for ICD, 50% (3) achieved the target dose of SV, 50% (3) were in NYHA class I and 50% (3) were in NYHA class II-III. One (17%) patient died for an unknown reason. HF hospitalization occurred in 4 (67%), of which 2 (33%) needed inotropic support and 1 (17%) was rehospitalised for HF. One (17%) patient had a ventricular tachycardia and consequently an appropriate ICD shock.</span></span></span></span></span></span></p>

<p><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Conclusion</span></span></span></span></strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Our findings suggest that in HFrEF, SV may provide favourable effects on LV function and HF symptoms and after a period of therapy some patients may no longer meet the criteria for prophylactic ICD implantation. ICD implantation has a high economic cost, and it is not devoid of serious harm. Consequently, SV treatment may definitely turn out to be cost-effective versus ICD implantation. This paradigm opens an entirely new approach to prevent sudden death in HFrEF patients.</span></span></span></span></span></span></p>