Lo mejor del Congreso Europeo de Insuficiencia Cardiaca ESC-HF París 2017 10/05/2017 18:00h http://ic17.secardiologia.es #PostIC17 Novedades en el tratamiento farmacológico de la IC crónica Dr. Julio Núñez Villota, Hospital Clínico Universitario de Valencia @yulnunezvill

2. Tratamiento farmacológico
de la insuficiencia cardiaca crónica
Dr. Julio Núñez
Hospital Clínico Universitario de Valencia

4. Study design
Co-primary endpoints: E/e’, distance walked in 6 minutes and
NT-proBNT at 8 months
Endpoints

5. Inclusion criteria

6. Flowchart

7. Study population

8. Tratamientos

9. Efficacy
Heart rate E/e´
6MWT NT-proBNP

10. Este y otros estudios ponen en tela de juicio el concepto ampliamente extendido
de que la bradicardia es beneficiosa en pacientes con IC y FEVI preservada.
¿¿¿ Betabloqueantes ???
«One of the first things taught in introductory
statistics textbooks is that correlation is
not causation. It is also one of the
first things forgotten.» Thomas Sowell.

12. Metaanálisis que incluye 17.368 pacientes con IC y
FEVI reducida incluidos en 11 ensayos clínicos

19. Early reverse remodeling and improvement of echo parameters after
introduction of sacubitril/valsartan in 80 stable and well treated HFrEF patients
Month 0 Month 3 P value
LV dimensions and function (N= 80)
LV end-diastolic diameter, mm 67.2 ± 8.6 65.5 ± 8.5 0.003
Anterior wall thickness, mm 7.1 ± 1.9 7.1 ± 17 0.57
LV end-diastolic volume, mL 218.8 ± 79.1 204.1 ± 79.3 <0.001
LV end-systolic volume, mL 158.9 ± 68.0 142.7 ± 70.1 <0.001
Cardiac output index, mL/min/kg 1.95 ± 0.48 2.06 ± 0.72 0.32
dP/dt, mmHg/s 553.7 ± 186.8 585.4 ± 275.8 0.86
LV ejection fraction, % 28.4 ± 7.7 31.9 ± 8.2 <0.001
Global longitudinal strain, % −7.4 ± 2.7 −8.8 ± 3.0 0.002
Diastolic function (N= 80)
E, m/s 79.7 ± 26.2 69.4 ± 24.7 <0.001
E deceleration time, ms 172.0 ± 55.8 199.8 ± 71.4 0.009
E/A 1.54 ± 0.95 1.21 ± 0.68 0.02
E/e’m 12.1 ± 5.9 9.8 ± 4.3 0.006
Left atrial volume index, mL/m2 43.7 ± 15.2 39.5 ± 13.9 0.005
V. Maurin, A. Canu, A. Bernard, S. Lafitte, F. Picard

20. Before treatment
After 3 months of
treatment
P value
RV dimensions and fonction (N= 70)
Tricuspid annulus, mm 35.4 ± 6.0 34.4 ± 5.2 0.26
Right ventricular diastolic area, cm² (N= 34) 19.5 ± 4.9 20.0 ± 4.3 0.64
Right atrial area, mm² (N= 34) 17.7 ± 6.3 17.2 ± 5.7 0.19
S’, cm/s 9.7 ± 2.7 10.0 ± 2.7 0.125
Isovolumic acceleration, cm/s² (N= 34) 1.9 ± 0.7 2.1 ± 0.9 0.20
Systolic pulmonary pressures, mmHg 42.5 ± 12.3 38.8 ± 12.0 0.012
Inferior vena cava dimension, mm 17.4 ± 4.6 15.8 ± 4.5 0.006
Inferior vena cava relative change, mm 42.4 ± 19.2 48.4 ± 19.4 0.38
Early reverse remodeling and improvement of echo parameters after
introduction of sacubitril/valsartan in 80 stable and well treated HFrEF patients
V. Maurin, A. Canu, A. Bernard, S. Lafitte, F. Picard

21. n= 41 pacientes