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Early left ventricular reverse remodeling after sacubitril-valsartan treatment. Subanalysis of SAVE-RLife study

Session Poster Session 2

Speaker Mario Galvan Ruiz

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : M Galvan Ruiz (Las Palmas De Gran Canaria,ES), M Singh (Las Palmas De Gran Canaria,ES), M Sanmamed Giron (Las Palmas De Gran Canaria,ES), M Groba Marco (Las Palmas De Gran Canaria,ES), M Lopez Perez (Las Palmas De Gran Canaria,ES), M Blanco Nuez (Las Palmas De Gran Canaria,ES), V Quevedo Nelson (Las Palmas De Gran Canaria,ES), P Pena Ortega (Las Palmas De Gran Canaria,ES), J Medina Suarez (Las Palmas De Gran Canaria,ES), D Rua-Figueroa Erausquin (Las Palmas De Gran Canaria,ES), JR Ortega Trujillo (Las Palmas De Gran Canaria,ES), JR Morales Gonzalez (Las Palmas De Gran Canaria,ES), E Caballero Dorta (Las Palmas De Gran Canaria,ES), A Garcia Quintana (Las Palmas De Gran Canaria,ES)

Authors:
M Galvan Ruiz1 , M Singh1 , M Sanmamed Giron1 , M Groba Marco1 , M Lopez Perez1 , M Blanco Nuez1 , V Quevedo Nelson1 , P Pena Ortega1 , J Medina Suarez1 , D Rua-Figueroa Erausquin1 , JR Ortega Trujillo1 , JR Morales Gonzalez1 , E Caballero Dorta1 , A Garcia Quintana1 , 1University Hospital of Gran Canaria Doctor Negrin - Las Palmas De Gran Canaria - Spain ,

On behalf: SAVE-RLife Group

Citation:

Introduction:  Few data on echocardiographic parameters of reverse remodeling has been published after the use of sacubitril-valsartan (SV) treatment.  Objective:  To analyse the reverse remodeling response in terms of echocardiographic parameters after the use of SV and evaluate the predictors for a left ventricular reverse remodeling.
Methods: This is an observational, ambispective, multicentre study that included all patients with stable HFrEF who started SV between SEP2016 and DEC2018. Patients with an echocardiogram (TTE) after at least 6 months of treatment were included.  Reverse ventricular remodeling was defined as an increase in LVEF=5%.
Results: A follow up TTE was perform in 84 out of 276 patients (30.4%). The mean age was 65 ± 10 y, 25% women. The main aetiologies of HFrEF were IHD (46.9%) and dilated cardiomyopathy (39.3%), and most frequent comorbidities were 69.3% hypertension, 44% DM, 50% Dyslipidemia, 31.3% AF and 27.4% CKD.  TTE values are shown in Table 1.  Patients with non-ischemic cardiomyopathy (non-IHD) had a greater improvement in LVEF (29.9±7.2 to 41.3±12.7 Vs non-IHD vs 30.4±6.9 to 32.7±9.8 in IHD patients). ; p<0.001) and a greater reduction of LVED (67.6±8 to 60.9±8.9 in non-IHD vs 62.53±7 to 60.50±8.1 in IHD, p<0.001). Other predictors of LV reverse remodeling are shown in Figure 1. 
Conclusions: In our study, SV improves LVEF and reverse remodeling. Predictors of reverse remodeling were: non-IHD etiology, earlier initiation of SV since diagnosis of HF, estimated glomerular filtration rate at baseline >60 ml/min and achievement of the highest dose of SV.

N=84

Baseline value

(mean±SD)

Follow - up value

(mean±SD)

MEAN DIFFERENT

P value

LVEF (%) (n = 84)

30.44± 7.41

37.83± 12

7.39

< 0.001

LVED (mm) (n = 84)

63.17± 8.75

61.36± 9

- 1.81

< 0.001

LA (mm) (n = 60)

46.46±7.14

43.15± 6.37

- 3.31

< 0.001

PAPs (mmHg) (n = 48)

42.38± 12.7

37.54± 12.7

-4.84

0.001

MI (grade 1 - 4) (n = 65)

1.59± 0.89

1.40± 0.867

- 0.19

< 0.001

LVEDV (ml) median (Q1- Q3) (n = 14)

173 (126 ; 223)

159 (115± 221)

- 14

0.530

E (mseg) (n= 15)

0.89± 0.21

0.72± 0.21

- 0.17

0.015

A (mseg) (n = 12)

0.57± 0.29

0.83± 0.275

0.26

0.010

E/A (n = 10)

1.79± 1.08

1.25± 1.10

- 0.54

0.139

Left ventricular ejection fraction (LVEF), Left ventricular end-diastolic diameter (LVED), left atrial diameter (LA), pulmonary artery pressure (PAPs), mitral insufficiency (MI), left ventricular end-diastolic volume (LVEDV), Pulmonary artery pressure (PAPs), Ischemic heart disease (IHD)

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