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Outcomes and safety of disopyramide and nadolol in a cohort of hypertrophic cardiomyopathy patients
Session:
Comunicações Orais - Sessão 21 - Miocardiopatia hipertrófica
Speaker:
Isabel Cardoso
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.7 Myocardial Disease - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Isabel Cardoso; José Miguel Viegas; Pedro Brás; Miguel Marques Antunes; Rita Teixeira; André Grazina; Ana Galrinho; Luísa Branco; Ana Leal; Sílvia Aguiar Rosa; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Disopyramide is a class Ia antiarrhythmic, used simultaneously with beta-blockers, to reduce left ventricle outflow tract (LVOT) gradient in hypertrophic cardiomyopathy (HCM) patients (P). Although its efficacy has been proven it is not widely used, in part for risk of arrhythmias. Furthermore, the combination of disopyramide and nadolol has limited access in our country. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong>To evaluate the efficacy and safety of disopyramide and nadolol in a cohort of obstructive HCM P. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We conducted a retrospective analysis of all HCM P treated with disopyramide and nadolol between January 2020 and October of 2022 at a cardiomyopathy clinic. Disopyramide and nadolol were initiated in symptomatic HCM patients with LVOT obstruction, refractory to maximally tolerated doses of beta-blockers and/or calcium-channel antagonists. The routine initial dose was 100 mg of disopyramide twice a day and nadolol 40 mg twice a day. An electrocardiogram (ECG) was performed at the day of disopyramide initiation and after one week to monitor the QT interval and heart rate (HR). In the absence of relevant corrected QT (cQT) interval prolongation disopyramide was titrated, as well as nadolol according to HR, to twice the dose. Correction for heart rate was made with Fridericia’s formula. Clinical and echocardiographic revaluation was performed after 3 months. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> 16P were included, 9 females (56%), mean age 54 ± 24 years, 4P (25%) had atrial fibrillation (AF), 8P (50%) had an Implantable Cardioverter Defibrillator (ICD), 2P (13%) underwent Morrow myectomy and 2P alcoholic septal ablation. Regarding the previous medication: 5P (31%) were treated with bisoprolol, 6P (38%) with bisoprolol and verapamil, 2 with carvedilol and 1 with propranolol. The mean basal LVOT gradient was 90 ± 38 mmHg, mean N-terminal pro b-type natriuretic peptide (NT-proBNP) 1238 ± 1025 pg/ml. There was a significant reduction in LVOT gradient in P treated with disopyramide and nadolol, mean LVOT gradient after 3 months was 44 ± 30 mmHg (p=0.047), 3P (19%) had LVOT gradient inferior to 30 mmHg. No recurrence of AF was identified. Of the patients started on disopyramide, 3 developed anticholinergic side effects: two xerostomia and one prostatism. In total 3P discontinued disopyramide: one due to cQT interval prolongation and 2 due to anticholinergic side effects. However, globally there was no significant cQT interval prolongation with disopyramide (p=0.63) (Table 1). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>Disopyramide and nadolol significantly reduced LVOT gradient, with no significant cQT interval prolongation or major adverse events. </span></span></p>
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