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Novedades en el manejo de la IC Aguda

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Ponencia presentada por el Dr. Domingo Pascual Figal en el directo online ‘Lo mejor del Congreso Europeo de IC Atenas 2019’, realizado en la Casa del Corazón el 5 de junio de 2019

Publié dans : Santé & Médecine
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Novedades en el manejo de la IC Aguda

  1. 1. LATE BREAKING TRIAL I – ACUTE HEART FAILURE Clinical phenotypes of AHF based on signs and symptoms of perfusion and congestion at ED presentation and their relationship with patient management and outcomes Miro O. Clinical phenotypes of AHF based on signs and symptoms of perfusion and congestion at ED presentation and their relationship with patient management and outcomes. Late breaking trial I – Acute heart failure. ESC HF 2019 | Javaloyes P, Eur J Heart Fail. 2019 May 24
  2. 2. Chioncel O. Acute heart failure congestion and perfusion status; impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC EORP HFA Heart Failure Long Term Registry. Late breaking trial I – Acute heart failure. ESC HF 2019 | Chioncel O., et al. European Journal of Heart Failure. 2017; 19: 1242–1254. LATE BREAKING TRIAL I – ACUTE HEART FAILURE AHF congestion and perfusión status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC EORP HFA
  3. 3. Miro C. Clinical phenotypes of AHF based on signs and symptoms of perfusion and congestion at ED presentation and their relationship with patient management and outcomes. Late breaking trial I – Acute heart failure. ESC HF 2019 | Miró O. Ann Intern Med. 2017;167(10):698-705. doi: 10.7326/M16-2726
  4. 4. Chioncel O. Acute heart failure congestion and perfusion status; impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC EORP HFA Heart Failure Long Term Registry. Late breaking trial I – Acute heart failure. ESC HF 2019 | Chioncel O., et al. European Journal of Heart Failure. 2017; 19: 1242–1254. doi:10.1002/ejhf.890.
  5. 5. Chioncel O. Acute heart failure congestion and perfusion status; impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC EORP HFA Heart Failure Long Term Registry. Late breaking trial I – Acute heart failure. ESC HF 2019 | Chioncel O., et al. European Journal of Heart Failure. 2017; 19: 1242–1254. doi:10.1002/ejhf.890.
  6. 6. LATE BREAKING TRIAL I – ACUTE HEART FAILURE Controlled decongestion by Reprieve Therapy™ in acute heart failure: the results of the TARGET-1 and TARGET-2 Studies Ponikowski P. Controlled decongestion by Reprieve Therapy™ in acute heart failure: the results of the TARGET-1 and TARGET-2 Studies. Late breaking trial I – Acute heart failure. ESC HF 2019
  7. 7. N= 1886 - Leicester, Paris, Basilea Kozhuharov A. Activity of the Adrenomedullin system to personalize post-discharge treatment in AHF. Studies. Late breaking trial I– Acute heart failure. ESC HF 2019 | Mullens W, et al. Eur J Heart Fail. 2019; 21(2): 137-155 I Nishikimi T, et al. Circ J. 2009; 73(5): 892-8
  8. 8. LATE BREAKING TRIAL I – ACUTE HEART FAILURE Lung Ultrasound Guided Treatment in Ambulatory Patients with HF: a Randomized Controlled Clinical Trial (LUS-HF study) Rivas M. Lung Ultrasound Guided Treatment in Ambulatory Patients with HF:a Randomized Controlled Clinical Trial (LUS-HF study). Studies. Late breaking trial I – Acute heart failure. ESC HF 2019 | Rivas-Lasarte M, et al. The Journal of Heart and Lung Transplantation 38(4): S141
  9. 9. Rivas M. Lung Ultrasound Guided Treatment in Ambulatory Patients with HF:a Randomized Controlled Clinical Trial (LUS-HF study). Studies. Late breaking trial I – Acute heart failure. ESC HF 2019 | Rivas-Lasarte M, et al. The Journal of Heart and Lung Transplantation 38(4): S141
  10. 10. End-point: mortalidad + visita a URGENCIAS + re-hospitalización por IC (6 meses seguimiento) Rivas M. Lung Ultrasound Guided Treatment in Ambulatory Patients with HF:a Randomized Controlled Clinical Trial (LUS-HF study). Studies. Late breaking trial I – Acute heart failure. ESC HF 2019 | Rivas-Lasarte M, et al. The Journal of Heart and Lung Transplantation 38(4): S141
  11. 11. LUNG ULTRASOUND IN AHF Prevalence of pulmonary congestion and associated short and long term outcomes Platz E, et al. Lung ultrasound in acute heart failure: prevalence of pulmonary congestion and associated short- and long-term outcomes. Rapid Fire 3 – Acute heart failure. ESC HF 2019 | Pierce S, et al. Nature Reviews Cardiology. 2017; 14: 427-440
  12. 12. Doble mecanismo de acción: 1. Inhibición Na-K ATPasa del sarcolema: Aumento de Cain sístole  Inotrópico 2. Activación SERCA2a: Aumento Cain diástole  Lusotrópico LATE BREAKING TRIAL I – ACUTE HEART FAILURE Safety and Efficacy of 24-hour Istaroxime Infusion in Patients Hospitalized for decompensated AHF Metra M. Safety and Efficacy of 24-hour Istaroxime Infusion in Patients Hospitalized for decompensated AHF. Late breaking trial I – Acute heart failure. ESC HF 2019 | Shah SJ, et al. Am Heart J. 2009; 157(6): 1.035-1.041. ClinicalTrials.gov Identifier: NCT02617446
  13. 13. Metra M. Safety and Efficacy of 24-hour Istaroxime Infusion in Patients Hospitalized for decompensated AHF. Late breaking trial I – Acute heart failure. ESC HF 2019 | Shah SJ, et al. Am Heart J. 2009; 157(6): 1.035-1.041. ClinicalTrials.gov Identifier: NCT02617446
  14. 14. In-hospital initiation of sacubitril/valsartan in stabilised patients with HrEF naïve to renin-angiotensin system blocker Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin- angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019 33% 67%
  15. 15. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin- angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019
  16. 16. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin- angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019
  17. 17. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin- angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019
  18. 18. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin- angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019
  19. 19. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin- angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019
  20. 20. 29% 71% Initiation of sacubitril/valsartan in patients with de novo HFrEF: an analysis of the TRANSITION study Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin- angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019 Parameters de novo HF N=286 Prior CHF N=705 p-value† Age (years), mean (SD) 63 (13) 69 (11) <0.001 Male, % 71 77 0.058 Caucasian, % 96 98 0.133 LVEF (%), mean (SD) 27 (8) 29 (7) <0.001 NYHA class II / III / IV, % 76 / 23 / 1 59 / 39 / 1 <0.001 eGFR* (mL/min/1.73m2), mean(SD) 67 (18) 60 (20) <0.001 Hypertension, % 58 82 <0.001 Diabetes, % 32 52 <0.001 Atrial fibrillation, % 36 53 <0.001
  21. 21. Proportion of patients (%) 7 87 63 45 3 91 72 56 0 20 40 60 80 100 97/103 mg bid S/V 49/51 or 97/103 mg bid S/V Any dose Permanent Discontinuation due to AE p<0.001 p=0.002 p=0.075 p=0.012 Most relevant AEs during 10 weeks 9 9 5 6 3 3 12 12 9 5 5 5 0 4 8 12 16 Proportionofpatients(%) Prior CHFde novo HF Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin- angiotensin system blocker: An analysis of the TRANSITION study. Rapid Fire 4 – Chronic heart failure: Pharmacology. ESC HF 2019
  22. 22. Proportionofpatients(%) ARBACEi BB Diuretics MRAs de novo HF 59 1 0,3 23 1 1 56 70 6865 90 90 48 65 62 0 25 50 75 100 20 0,4 0,4 15 0 0,4 16 76 75 16 86 79 4 63 60 0 25 50 75 100 Prior CHF Prior to admission Week 10 Week 26 de novo HF 271 258 259 Prior CHF 680 642 628 0 10 20 30 de novo HF 265 254 254 Prior CHF 661 625 606 400 800 1200 1600 2000 pg/mL Randomisation NT-proBNP hs-Troponin-T Week 4 Week 10 ng/L Prior CHF de novo HF p=0.393 p<0.001 p<0.001 p=0.001 p<0.001 p<0.001 Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin- angiotensin system blocker: An analysis of the TRANSITION study. Rapid Fire 4 – Chronic heart failure: Pharmacology. ESC HF 2019
  23. 23. Initiation of sacubitril/valsartan rather than an ACE-I or an ARB may be considered for patients hospitalised with new-onset HF or decompensated CHF to reduce the short-term risk of adverse events and to simplify management (by avoiding the need to titrate ACE-I first and then switch to sacubitril/valsartan). Because these patients are already at high risk of events, there is no need to check plasma concentrations of natriuretic peptides prior to initiating sacubitril/valsartan. Seferovic PM, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of The Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019: ejhf.1531.
  24. 24. • La congestión residual es un elemento clave en la evaluación. • La ecografía pulmonar como herramienta diagnóstica. • En ausencia de terapias específicas, la optimización de los fármacos modificadores de la enfermedad pre-alta. • Sacubitrilo-valsartán: seguro en naïve para IECA/ARAII, y fármaco modificador de la enfermedad en primera línea para pacientes hospitalizados, incluidos de novo.

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