Use of Sacubitril/Valsartan in a Chronic Heart Failure Patient with Reduced Ejection Fraction Accompany Dilated Cardiomyopathy and Myocardial Indensification: A Case Report

Abstract Rationale: Dilated cardiomyopathy (DCM) is a progressive cardiac disease characterized by ventricular dilation and contractile dysfunction and is the third most common cause of heart failure and the most common cause of heart transplantation. Heart failure (HF) and atrial fibrillation (AF) often coexist and share a mutually beneficial relationship. The presence of atrial fibrillation increases the tendency for heart failure, which can worsen its severity and increase the risk of stroke. DCM、AF and HF are causal to each other in pathophysiological view. However, how these pathogens translates upon acute decompensation heart failure(ADHF) is unknown. Control acute attack of chronic heart failure is the first step of treatment.Case summary: Herein, we described a 68-year-old man with acute decompensated heart failure (ADHF) with severe DCM and atrial fibrillation who was treated with Sacubitril/Valsartan and had a reduced ejection fraction. The patient’s echocardiography features had a significant improvement under taking Sacubitril/Valsartan. Sacubitril/Valsartan may act as an intermediary that balancing of the good and the bad neuroendocrine response.Discussion: DCM is a major cardiomyopathy and a major cause of heart transplantation. DCM’s clinical prognosis is poor, additionally, along with myocardial indensification, early diagnosis and treatment is helpful to prolong the patients' life. The emergence of Sacubitril/Valsartan represents the advent of a new strategy for treating HFrEF. Its beneficial effects are related in part, at least, to an improvement of echocardiographic features and positive modulation of the neuroendocrine response to HF.

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P3542Natriuretic peptides added to clinical parameters predict two-year prognosis of patients with chronic heart with mid-range and reduced ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz745.0405 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Spinar ◽

L Spinarova ◽

M Spinarova ◽

K Labr ◽

J Jarkovsky ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Heart Transplantation ◽

Natriuretic Peptides ◽

Prognostic Score ◽

Clinical Status ◽

Reduced Ejection Fraction ◽

Nyha Classification ◽

Patients With Heart Failure

Abstract Background The guidelines recommend to determine natriuretic peptides, clinical status (NYHA classification) and comorbidities in order to predict the prognosis in patients with heart failure. The aim ofthis registry was to develop a prognostic score in chronic heart failure patients, using clinical status, comorbidities and natriuretic peptides. Methods Consecutive 1088 patients with stable chronic heart failure with reduced ejection fraction (HFrEF) (LVEF<40%) and mid-range EF (HFmrEF) (LVEF 40–49%) were enrolled. Two-year all-cause mortality, heart transplantation and/or LVAD implantation were defined as the primary endpoint (MACE). Results The occurrence of MACE was 14.9% and increased with higher NYHA, 4.9% (NYHA I), 11.4% (NYHA II) and 27.8% (NYHA III-IV) (p<0.001). The occurrence of MACE was 3%, 10% and 15–37% in patients with NT-proBNP levels ≤125pg/ml, 126–1000pg/ml and >1000pg/ml respectively. Discrimination abilities of NYHA and NT-proBNP were (AUC 0.670; p<0.001 and AUC 0.722; p<0.001). The predictive value of the developed clinical model, which took account of older age, advanced heart failure (NYHA III+IV), anaemia, hyponatraemia, hyperuricaemia and taking a higher dose of loop diuretics (>40 mg furosemide daily) (AUC 0.773; p<0.001) was increased by adding the NT-proBNP level (AUC 0.790). Conclusion Natriuretic peptides, clinical status and comorbiditis predict two year prognosis and they can help to a better identification of a high-risk groups of patients with heart failure with reduced and mid range ejection fraction in which more intense treatment should be considered, mainly LVAD implantation or listing to heart transplantation waiting list. Acknowledgement/Funding None

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SAT-470 When The Heart Can’t Clap To The Thyroid’s Beat

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1182 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Aditi Thakkar ◽

Maria Camila Trejo-Parades ◽

Anantha Sriharsha Madgula ◽

Margaret Stevenson

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Ejection Fraction ◽

Dilated Cardiomyopathy ◽

Ischemic Cardiomyopathy ◽

Left Ventricular ◽

Reduced Ejection Fraction ◽

Tachycardia Induced Cardiomyopathy

Abstract Hyperthyroidism is associated with multiple cardiac pathologies including dilated cardiomyopathy, isolated right ventricular heart failure, and atrial fibrillation (AF). Long standing untreated hyperthyroidism in conjunction with AF can cause severe dilated cardiomyopathy with reduced ejection fraction that is completely reversible with treatment. We present the case of a previously healthy male who presented with florid congestive heart failure (CHF) as an initial presentation for hyperthyroidism. A 37-year-old male presented to the emergency department with progressively worsening dyspnea on exertion and lower extremity edema for one month. His heart rate was noted to be 172 bpm and an EKG was done that showed AF. He was clinically noted to be in heart failure and was admitted for further management. He was started on metoprolol with good heart rate control and was started on furosemide for diuresis. A transthoracic echocardiogram was done and showed severe global hypokinesis with left ventricular ejection fraction reduced to 20% along with bi-atrial enlargement and dilated left ventricular cavity. Ischemic cardiomyopathy was ruled out with left heart catheterization. A TSH level was checked as a part of workup for non-ischemic cardiomyopathy and atrial fibrillation and was markedly reduced to <0.01mIU/L with free T4 of 1.49ng/dL and free T3 of 6.7ng/dL. A diagnosis of hyperthyroid cardiomyopathy with concomitant tachycardia induced cardiomyopathy was made. Autoimmune workup was negative for anti-thyroid-peroxidase and anti-thyroid-stimulating antibodies. Ultrasound of his thyroid gland revealed multiple thyroid nodules concerning for toxic multinodular goiter. He was started on methimazole and discharged after volume optimization with diuresis to closely follow up with endocrinology and cardiology for further management. CHF can be the primary presentation in about 6% of patients with hyperthyroidism. T3 is the main thyroid hormone that binds to cardiomyocytes. It increases the expression of beta-adrenergic receptors on cardiomyocytes and subsequently increases heart rate and contractility. T3 can also cause atrial arrhythmias such as AF by decreasing the parasympathetic tone. Concomitant AF and hyperthyroidism can cause reduced ejection fraction due to tachycardia induced cardiomyopathy and dilated cardiomyopathy. Treatment mainly is with beta-blockers that slow down the heart as well decrease serum T3 levels by blocking 5-monodeiodinase which converts T4 to T3. Our patient was started on beta-blocker and methimazole with good reduction in heart rate and improvement of symptoms. Recovery of cardiac function will be assessed with longitudinal follow up. As hyperthyroidism is one of the few causes of CHF that is completely reversible, clinicians must maintain low degree of suspicion in patients with new onset heart failure especially when associated with AF.

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Predictors of Unfavorable Outcomes in Patients with Atrial Fibrillation and Concomitant Heart Failure with Different Ejection Fractions: RIF-CHF Register One-Year Follow-Up

Cardiology Research and Practice ◽

10.1155/2019/1692104 ◽

2019 ◽

Vol 2019 ◽

pp. 1-14

Author(s):

Igor Zhirov ◽

Natalia Safronova ◽

Yulia Osmolovskaya ◽

Alina Alshevskaya ◽

Andrey Moskalev ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Cardiovascular Mortality ◽

Reduced Ejection Fraction ◽

Increased Risk ◽

Long Term Treatment ◽

Patient Groups ◽

One Year

Background. Atrial fibrillation (AF) and heart failure (HF) are tightly interrelated. The concurrence of these pathologies can aggravate the pathological process. The geographic and ethnic characteristics of patients may significantly affect the efficacy of different types of therapy and patients’ compliance. The objective of this study was to analyze how the features of the course of the diseases and management of HF + AF influence the clinical outcomes. Methods. The data of 1,003 patients from the first Russian register of patients with chronic heart failure and atrial fibrillation (RIF-CHF) were analyzed. The endpoints included hospitalization due to HF worsening, mortality, thromboembolic events, and hemorrhage. Predictors of unfavorable outcomes were analyzed separately for patients with HF and preserved ejection fraction (AF + HFpEF), midrange ejection fraction (AF + HFmrEF), and reduced ejection fraction (AF + HFrEF). Prevalence of HF + AF and compliance with long-term treatment of this pathology during one year were evaluated for each patient. Results. The study involved 39% AF + HFpEF patients, 15% AF + HFmrEF patients, and 46% AF + HFrEF patients. AF + HFpEF patients were significantly older than patients in two other groups (40.6% of patients were older than ≥75 years vs. 24.8%, respectively, p<0.001) and had the lowest rate of prior myocardial infarctions (25.3% vs. 46.1%, p<0.001) and the lowest adherence to rational therapy of HF (27.4% vs. 47.1%, p<0.001). AF + HFmrEF patients had the highest percentage of cases of HF onset after AF (61.3% vs. 49.2% in other patient groups, p=0.021). Among patients with AF + HFrEF, there was the highest percentage of males (74.2% vs. 41% in other patient groups, p<0.001) and the highest percentage of ever-smokers (51.9% vs. 29.4% in other patient groups, p<0.001). A total of 57.2% of patients were rehospitalized for decompensation of chronic heart failure within one year; the risk was the highest for AF + HFmrEF patients (66%, p=0.017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15.5% vs. 5.4% in other patient groups, p<0.001) rather than ischemic stroke (2.4% vs. 3%, p=0.776). Patients with AF + HFpEF had lower risk to achieve the combination point (stroke + IM + CV death) as compared to patients with AF + HFmrEF and AF + HFrEF (12.7% vs. 22% and 25.5%, p<0.001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and administered treatment had different effects on the risk of unfavorable outcomes depending on ejection fraction group. The clinical features and symptoms were found to be significant risk factors of cardiovascular mortality in AF + HFmrEF, while therapy characteristics were not associated with it. Conclusions. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with the development of unfavorable outcomes. The demographic and clinical characteristics of patients with midrange ejection fraction demonstrate that these patients need to be studied as a separate cohort.

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