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ARNi treatment in adults with Tetralogy of Fallot – A single-centre experience
Session:
Sessão de Posters 49 - Cardiopatias Congénitas
Speaker:
André Paulo Ferreira
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.6 Congenital Heart Disease – Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
André Paulo Ferreira; Inês Ferreira Neves; Tânia Branco Mano; Tiago Rito; Pedro Oom da Costa; Rui Cruz Ferreira; Lídia de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Background: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">Surgical correction of Tetralogy of Fallot (TOF), typically performed in early childhood, has significantly improved survival rates.</span></span> <span style="font-size:11.0pt"><span style="color:black">However, a substantial number of adults with repaired TOF still develop heart failure with reduced ejection fraction (HFrEF). The potential benefits of Angiotensin Receptor-Neprilysin Inhibitors (ARNi), such as Sacubitril/Valsartan (SV), in this subgroup are still not well established. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Purpose: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">To evaluate the potential reverse cardiac remodelling effects of SV in adult patients with TOF and depressed ventricular function.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Methods: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">A single-centre, retrospective study of adult patients with TOF and depressed left ventricle ejection fraction (LVEF) who received SV therapy between 2020 and 2023. Relevant clinical and echocardiographic data before and after SV therapy initiation was assessed. Patients were clinically evaluated every 3-6 months and therapy was titrated if possible.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Results:</span></span></strong><strong> </strong><span style="font-size:11.0pt"><span style="color:black">A total of 6 TOF patients who received SV therapy during the study period were included. Patient’s mean age was 46.6±11.5 years, and 83.3% were male. After a median SV therapy duration of 24.0 [IQ 13.5-37.5] months, there was a significant improvement in LVEF (36.2±6.9% vs 44.6±5.4%, p=0.02) and in end-diastolic volume (181.2±19.1ml vs 134.0±50.3ml, p=0.03). There was no effect in the tricuspid annular plane systolic excursion of the subpulmonary ventricle (16.8±3.0mm vs 17.2±2.7mm, p=0.37). The medication was titrated up to the maximum tolerated dose in all patients. Adverse events were generally well-tolerated, and no significant safety concerns were identified. Adherence to therapy was maintained by all patients. During follow-up, 66.7% reported an increase in functional class status (New York Heart Association Class). Four patients were evaluated by cardiopulmonary exercise test at baseline and at 12 months after SV initiation, showing improvement in maximal oxygen uptake (14.4 vs. 16.4 ml/kg/min), and exercise duration (394.4 vs. 550.3 sec). No patients were hospitalised due to heart failure or other cardiovascular events, and there was no mortality.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">This retrospective study provides initial evidence supporting the potential benefits of SV in adults with TOF and reduced ejection fraction. The observed improvements in LVEF and symptomatology suggest a potential role for SV in the medical management of TOF-related HFrEF. </span></span></span></span></p>
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