The combined effect of Sacubitril-valsartan treatment on right ventricular function and cardiorespiratory response in patients with chronic heart failure

 

Cardiorespiratory response, right ventricular and global diastolic function is known to deteriorate the clinical course of patients with chronic heart failure with reduced ejection fraction (HFrEF), even under optimal treatment. In this work we sought to evaluate the impact of sacubitril/valsartan initiation in patients with chronic HFrEF in NYHA clinical status II-III, under optimal medical and invasive treatment. Methods 180 patients (85% male, mean age 62±9 years old, 60% ischemic heart failure, 73% with ICD, 45%with CRT and 45% with diabetes mellitus) in NYHA classification II-III-, who were prescribed Sacubitril-Valsartan were evaluated.

Clinical status, biochemical parameters, cardiorespiratory exercise response and bi-ventricular Doppler indices were evaluated at first visit and 6 months after. The pulsed tissue Doppler imaging of the systolic and diastolic function of mitral and tricuspid annulus was characterized by the systolic waves Smv and Stv, and the diastolic waves: Emv and Amv; E was the early filling wave in transmitral velocity. Left atrial maximal volume and global longitudinal strain of the left ventricle (GLPS) were measured. In cardiorespiratory exercise Vo2max, VE/VCO2 and Mets achieved were evaluated. All of them received b-blockers, 90% eplerenone or spironolactone, 25% ivabradine and 90% diuretic treatment. Seventy percent of them started with the dose of 50mg of sacubitril/valsartan; while 80% finally received the full dose of 200 mg bid. One third of them were on clinical status NYHA III.

Results

Eight of the patients discontinued the medication due to hypotension or renal function worsening. All patients expressed improvement in clinical status; while diuretic therapy was down titrated in all of them and discontinued in 30%. As compared with the initial examination, tricuspid annulus systolic wave velocity increased by 5% (p=0.04); maximum volume of left atrium was decreased by 6% (p=0.004); GLPS average was improved by 41% (p=0.001) and E/Emv ratio was decreased by 22% (p=0.04). Moreover, improvement in Stv was more prominent in DCM as compared to IHF patients; In cardio respiratory exercise VE/VCO2 decreased by 5% (p=0.05); while VO2 max showed a trend in improvement (p=0.06), with no difference detected between DCM and ICM patients; although there was a significant increase (47%) in METS achieved (p=0.02).

Conclusion

Sacubitril/valsartan initiation was associated with improved left diastolic function and right ventricular function, along with functional status improvement in patients with HFrEF. These finding underline the beneficial role of sacubitril/valsartan initiation on the hemodynamic course of patients with systolic heart failure and clinical status deterioration.

Funding Acknowledgement

Type of funding source: None

Intestinal neurofibromatosis and small-bowel adenocarcinoma: a single case study

OBJECTIVE

Patients with Von Recklinghausen's disease (neurofibromatosis type 1) are at increased risk of developing various tumours. However, the coexistence of neurofibromatosis with small-bowel adenocarcinoma is exceedingly rare. We present an uncommon case of neurofibromatosis type 1, involving the small bowel in a 73-year-old man, who was admitted to our department with signs of acute abdomen. At laparotomy, multiple mesenteric and intramural nodules were seen in the distal ileum. These nodules obstructed ileal lumen, while the intestine wall was perforated in one point. A wide resection of the affected ileum together with all visible nodules in the adjacent mesentery was performed. Histology revealed neurofibromatosis type 1 with malignant transformation to small-bowel adenocarcinoma. The patient had no additional therapy. In a follow-up of 2 years, the patient is very well and there was no recurrence of the disease. We suggest that adenocarcinoma of small bowel should be considered in the evaluation of acute abdominal pain in neurofibromatosis patients.

Pre- and postoperative psychological characteristics in morbidly obese patients

BACKGROUND

Quality of life is poor in morbidly obese patients, because of impaired physical and psychosocial functioning. Surgical treatment offers long-term weight reduction and amelioration of most associated comorbidities. Studies of the effect of weight loss on patients' mental well-being are required, because discrimination and psychopathologic consequences represent a heavy burden.

PATIENTS AND METHODS

53 patients were interviewed 48 hours before vertical banded gastroplasty (VBG) by the psychiatric team and completed the self-administered SCL-90-R questionnaire. Correlations of patients' age, educational level, employment, duration of obesity and family conditions were investigated and compared with the degree of obesity 10-12 months postoperatively. 35 patients returned to psychiatric follow-up and completed the same questionnaire, and the various psychopathologic characteristics were compared to the preoperative ones.

RESULTS

Females had statistically significant higher scores in all psychopathologic parameters studied; more obvious differences were seen in depression (P < 0.001), paranoid ideation (P < 0.001) and interpersonal sensitivity (P < 0.001). Correlations of several demographic characteristics with the patients' preoperative BMI were negative. 10-12 months following VBG, statistically significant improvement in the parameters of phobic anxiety, obsessions-compulsions, paranoid ideation and interpersonal sensitivity (P < 0.05) were found.

CONCLUSION

Pre-existing psychopathology was more obvious among females, and improved significantly following successful weight loss 1 year postoperatively.

Ulcerative colitis and acute stroke: two rare complications after Mason's vertical banded gastroplasty for treatment of morbid obesity

The authors present a very rare case of ulcerative colitis and acute stroke appearing as complications after Mason's vertical banded gastroplasty for treatment of morbid obesity in a 46-year-old man. On the basis of recent studies, the authors attempt to find the correlation of these three diseases and the possible effect of each disease on the appearance of the others. The dilemmas in the treatment of this patient are also described.