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Sacubitril-valsartan: does the functional class improve objectively estimated by cardiopulmonary exercise testing?

Session Poster Session 1

Speaker Cristina BELTRAN HERRERA

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Treatment, Other
  • Session type : Poster Session

Authors : C Beltran Herrera (Madrid,ES), V Suberviola (Madrid,ES), S Briongos (Madrid,ES), M Sarrion (Madrid,ES), A Sanchez (Madrid,ES), C Cortina (Madrid,ES), ML Giganto (Madrid,ES), E Gomez (Madrid,ES), R Munoz (Madrid,ES)

Authors:
C Beltran Herrera1 , V Suberviola1 , S Briongos1 , M Sarrion1 , A Sanchez1 , C Cortina1 , ML Giganto1 , E Gomez1 , R Munoz1 , 1University Hospital Infanta Leonor - Madrid - Spain ,

Topic(s):
Chronic Heart Failure: Treatment, Other

Introduction

The new drug Sacubitril-Valsartan (ARNI) has demonstrated to improve the functional class (FC) measured by NYHA in patients (pts) with heart failure (HF) and ventricular dysfunction. The most objective method of assessing FC in HF is the peak oxygen uptake (Vo2) in a cardiopulmonary exercise testing (CPET). Our objective is to assess whether the use of ARNI in pts with HF also improves the FC measured by peakVo2.

Methods
We analyzed 31 pts with HF and left ventricular dysfunction from October 2016 to March 2017 which had been treated with Sacubitril-Valsartan evaluated in a cardiology day clinic. The FC was evaluated by NYHA before treatment, on the first and third month. CEPT was performed on the third month in 9 pts, and then compared with a baseline test before ARNI available in 5 pts. According to the % peak of Vo2 reached predicted by Wasseman values it was estimated that, the FC  was: normal FC> 80% predicted, FC slightly reduced 60-79%, FC moderately reduced 59-50% and FC severely reduced <50%.

Results
80% males, 71 ± 10 years, LVEF 27 ± 5%, NTproBNP 3123 ± 2811, 49% ischemic C., 39%  idiopathic C. 96.8% pts take beta-blockers, 58.1% MRA. The NYHA FC pretreatment, first and third month after treatment is shown in the graph, there was a significant improvement with the drug. The absolute value of peak vO2 as well as its values predicted at baseline and in the third month are shown in the table and graphs. Except in 1 patient, there was absolute improvement in the peak Vo2 measured in the third month, and in the FC estimated by CEPT. The pte that didn´t show improvement maintained a normal capacity before and after treatment. If the FC is compared at third month as estimated by NYHA and Vo2, there are discrepancies, 100% in FC I-II by NYHA and 55% in FC I-II by peak vO2 (graph)

Conclusions
In our real life series, ARNI significantly improves the FC determined by NYHA. If the FC is estimated by peak Vo2, more objective, pts tend to present worse functional class than measured by NYHA. Even so, the absolute values of peak Vo2 and the FC estimated by this parameter improve after 3 months of ARNI. These are preliminary data and further studies are required in this regard but we point out that sacubitril-valsartan is an effective drug in the functional improvement of these pts.

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