RESUMEN
INTRODUCTION: Sacubitril/valsartan (S-V) has been shown to reduce clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This benefit has been mostly attributed to an improvement in systolic function. AIM: This study aimed to evaluate longitudinal changes in several echocardiographic parameters of diastolic function in a cohort of patients with HFrEF receiving S-V. METHODS: Echocardiographic parameters of consecutive patients receiving S-V, such as diastolic dysfunction (DD) grade and other individual diastolic and systolic function parameters, were prospectively collected at baseline and at 6-month follow-up. New York Heart Association (NYHA) functional class was also recorded. RESULTS: 65 patients (73.9% males; 61.5 ± 13 years) with HFrEF in NYHA class II-IV were evaluated. There was a significant reduction in DD grade after treatment with maximal tolerated doses (p < 0.001). Patients with advanced DD showed the most significant improvements: 75% and 60% of patients with initial grade 3 and 2, respectively, had better grade after 6 months of S-V. Moreover, there was a reduction in E/e' ratio (p = 0.004), left atrial longitudinal strain (p = 0.002), and an improvement of left ventricle ejection fraction (p < 0.001) and NYHA functional class (p = 0.001). Among those subjects who improved their functional class, a higher percentage improved their DD grade (39.3%, p = 0.025) in comparison with those not improving their NYHA class (25%, p = 0.434). CONCLUSIONS: In addition to an improvement in systolic function parameters, patients with HFrEF receiving S-V improved their diastolic function. This echocardiographic improvement is particularly relevant in those patients with better NYHA class at 6-month follow-up.
Asunto(s)
Aminobutiratos/uso terapéutico , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Neprilisina/antagonistas & inhibidores , Inhibidores de Proteasas/uso terapéutico , Volumen Sistólico/efectos de los fármacos , Tetrazoles/uso terapéutico , Función Ventricular Izquierda/efectos de los fármacos , Anciano , Aminobutiratos/efectos adversos , Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Compuestos de Bifenilo , Diástole , Combinación de Medicamentos , Ecocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inhibidores de Proteasas/efectos adversos , Recuperación de la Función , Tetrazoles/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , ValsartánRESUMEN
Mediante cardiorresonancia es posible realizar estudios de detección de isquemia miocárdica en condiciones de estrés, evaluando la perfusión miocárdica, la contractilidad miocárdica o ambas con una elevada exactitud diagnóstica. En este capítulo analizamos los protocolos de estudio, sus indicaciones y limitaciones, así como los valores diagnósticos (AU)
Stress cardiac magnetic resonance imaging is useful for detecting myocardial ischemia. The technique can be used to assess myocardial perfusion and contractility with a high degree of accuracy. In this article, we review study protocols, indications for and limitations of the technique, and the techniques diagnostic value (AU)