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Sacubitril/Valsartan in adults with congenital heart disease and depressed ventricle function
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; Rita Teixeira; 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">Previous studies have shown that Sacubitril/valsartan (SV) promotes favourable cardiac remodelling in heart failure patients with reduced ejection fraction. However, data regarding the effects of SV in adults with congenital heart disease (ACHD) and depressed ventricular function is still lacking.</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 demonstrate the reverse cardiac remodelling effects of SV in ACHD with 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 ACHD patients with depressed systemic ventricle ejection fraction (SVEF) who received SV therapy between January 2019 and May 2023. Baseline and clinical characteristics were assessed. Transthoracic echocardiogram (TTE) data was analysed before and after SV therapy initiation. Patients without TTE data after a minimum of six months of SV therapy were excluded from the study.</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 17 patients who received SV therapy during the study period were included. Patient’s mean age was 54.1±16.0 years, and 76.5% were male. The primary diagnoses were: Tetralogy of Fallot (n=6), interventricular septum defect (n=3), patent ductus arteriosus (n=2), cor triatriatum sinister (n=1), dextro-transposition of the great arteries (n=1), subpulmonary stenosis (n=2), subaortic stenosis (n=1), and univentricular heart (n=1). One patient had a right systemic ventricle. After a median SV therapy duration of 23.0 [IQ 15.5-46.0] months, there was a significant improvement in SVEF (38.9±9.0% vs 48.1±9.8%, p=0.01) and in end-diastolic diameter (62.3±9.2mm vs 54.8±12.9mm, p=0.04), as well as in the annular plane systolic excursion of the subpulmonary ventricle (15.5mm [IQ 14.0-18.0] vs 17.8mm [IQ 15.0-20.0], p=0.02). There was no effect in diastolic function parameters, such as the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (9.0±3.6 vs 9.3±5.2, p=0.53). The medication was temporarily discontinued in 1 patient due to symptomatic hypotension. During follow-up, 11 patients (64.7%) reported an increase in functional class status (New York Heart Association Class), 2 patients were hospitalised due to heart failure, and 2 patients died (one due to Sars-Cov infection and another of unknown causes).</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">In a cohort of ACHD with depressed systemic ventricle function, SV showed beneficial reverse cardiac remodelling by improving SVEF and reducing end-diastolic diameters. More extensive studies are needed to corroborate these results.</span></span></span></span></p>
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