Effects of early initiation of comprehensive heart failure therapy on echocardiographic parameters of young patients with newly diagnosed idiopathic dilated cardiomyopathy

Funding Acknowledgements

Type of funding sources: None.

Introduction

Heart failure with reduced ejection fraction (HFrEF) is a growing problem worldwide and is associated with significant morbidity and mortality. Angiotensin receptor neprilysin inhibitors (ARNI) and sodium-glucose cotransporter 2 inhibitors (SGLT2-i) are now seen as disease modifying agents with growing evidence to support their early initiation in order to prolong lives of patients with HFrEF. However, most of these trials were conducted in the developed world involving older patients with ischaemic cardiomyopathies, in contrast to younger patients with idiopathic dilated cardiomyopathies (DCMO) typically seen in Africa. Further, these drugs are expensive and remain out of reach for most patients in the developing world.

Purpose

To determine the effects of early initiation of comprehensive heart failure (HF) therapy consisting of ARNI, SGLT2-i, β-blocker and mineralocorticoid receptor antagonist on transthoracic echocardiography (TTE) parameters of patients with newly diagnosed idiopathic DCMO.

Methods

This is prospective cohort study. All patients presenting to a single tertiary centre in South Africa between January and July 2021 with newly diagnosed idiopathic DCMO that were initiated on a regimen of comprehensive heart failure therapy as first line therapy were included. TTE were performed at initiation and at monthly follow up visits.

Results

Eight patients (mean age 35.4 ± 7 years, 25% females) were included. At baseline, the mean left ventricular ejection fraction (LVEF) was 17.1 ± 3.2%, mean left ventricular end diastolic diameter (LVEDD) was 68.0 ± 7.6mm, mean E’ (average) 4.0 ± 1.9m/s, mean LV global longitudinal strain (GLS) -4.5 ± 1.9%, mean LVOT VTI 10.9 ± 3.2cm and mean TAPSE 14.3 ± 4.1mm. The patients were followed up for an average of 4 months (range 1 – 5 months). TTE performed at the latest follow up visit showed a significant increase in LVEF (21.3%; 95% CI 13.5 - 29.0; p = 0.01), average E’ (2.5m/s; 95% 0.3 - 4.7; p = 0.05), GLS (-6.7%; 95% CI -1.0 - 8.9; p = 0.01), LVOT VTI (5.0cm; 95% CI 1.4 - 8.5; p = 0.03) and TAPSE (7mm; 95% CI 2.6 - 11.4; p = 0.02), and a significant reduction in LVEDD (6.5mm; 95% CI 1.1 - 11.9; p = 0.03).

Conclusion

Early initiation of comprehensive HF therapy including ARNI and SGLT2-i is associated with significant improvements in left and right ventricular function and LV reverse remodelling in a small cohort of young South African patients with newly diagnosed idiopathic DCMO. This supports the widespread adoption of this therapeutic strategy, even in a resource limited setting, in a population of patients with limited access to other therapeutic options such as mechanical circulatory support and cardiac transplantation. Abstract Table 1  Abstract Figure 1