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Early left ventricular reverse remodeling after sacubitril-valsartan treatment. Subanalysis of SAVE-RLife study
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)
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
Topic(s): Chronic Heart Failure: Pharmacotherapy
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)
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.