Author Correction: Impact of sacubitril/valsartan on implantable defibrillator eligibility in heart failure: a real-world experience

Correction to: European Review for Medical and Pharmacological Sciences 2021; 25 (18): 5690-5700-DOI: 10.26355/eurrev_202109_26788-PMID: 34604961, published online on 30 September 2021. After publication, the authors applied to change the first two lines of Table II as the second column results were erroneously shifted in the first column. In this way, the results were quite difficult to understand. There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/26788.

Impact of sacubitril/valsartan on implantable defibrillator eligibility in heart failure: a real-world experience

OBJECTIVE

Current guidelines recommend an implantable cardiac defibrillator (ICD) in patients with symptomatic heart failure and reduced ejection fraction (HFrEF; left ventricular ejection fraction [LVEF] ≤35%) despite ≥3 months of optimal medical therapy. Recent observations demonstrated that sacubitril/valsartan induces beneficial reverse cardiac remodeling in eligible HFrEF patients. Given the pivotal role of LVEF in the selection of ICD candidates, we sought to assess the impact of sacubitril/valsartan on ICD eligibility and its predictors in HFrEF patients.

PATIENTS AND METHODS

We retrospectively evaluated 48 chronic HFrEF patients receiving sacubitril/valsartan and previously implanted with an ICD in primary prevention. We assumed that ICD was no longer necessary if LVEF improved >35% (or >30% if asymptomatics) at follow-up.

RESULTS

Over a median follow-up of 11 months, sacubitril/valsartan induced a significant drop in LV end-systolic volume (-16.7 ml/m2, p=0.023) and diameter (-6.8 mm, p=0.022), resulting in a significant increase in LVEF (+3.9%, p<0.001). As a consequence, 40% of previously implanted patients resulted no more eligible for ICD at follow-up. NYHA class improved in 50% of the population. A dose-dependent effect was noted, with higher doses associated to more reverse remodeling. Among patients deemed no more eligible for ICD, lower NYHA class (odds ratio (OR) 3.73 [95% CI 1.05; 13.24], p=0.041), better LVEF (OR 1.23 [95% CI 1.01; 1.48], p=0.032) and the treatment with the intermediate or high dose of sacubitril/valsartan (OR 5.60 [1.15; 27.1], p=0.032) were the most important predictors of status change.

CONCLUSIONS

In symptomatic HFrEF patients, sacubitril/valsartan induced beneficial cardiac reverse remodeling and improved NYHA class. These effects resulted in a significant reduction of patients deemed eligible for ICD in primary prevention.

P1151Impact of ARNI (LCZ696) on patients selection for ICD implantation in SCD primary prevention: a real-world experience

Background

 ICD implantation is recommended for primary prevention in patients with symptomatic NYHA II-III heart failure with reduced ejection fraction (&lt; 35%) (HFrEF) and without left ventricle ejection fraction (LVEF) improvement despite at least three months of guideline-directed therapy. The use of angiotensin receptor-neprilysin inhibition with LCZ696 has shown to ameliorate left ventricle function and to reduce the ventricular arrhythmias burden in patients with HFrEF.

Purpose

The profile of patients with HFrEF who may benefit from therapy with LCZ696 without further requiring an ICD in primary prevention is still unknown. We aimed to assess the prevalence of these patients and to find potential clinical predictors of responsiveness to this treatment.

Methods

 We enrolled consecutive patients that started LCZ696 treatment for medical therapy optimization in the heart failure clinic of our institution. All of them were previously implanted with an ICD before LCZ696 availability (from 2009 to 2015). A cardiologist evaluated their home medications, clinical, and echocardiographic characteristics both at baseline (before starting LCZ696) and during follow up. The patients were grouped also according to the etiology of HF (ischemic/non-ischemic) and by gender. Patients were excluded if candidates to cardiac resynchronization therapy. Responsiveness to LCZ696 treatment was defined as an increase of LVEF to values &gt; 35% at follow up (FU).

Results

A total of 49 patients (67.1 ± 9.8 years of age) were enrolled in this study and followed in the heart failure clinic of our institution (mean follow up 11.5 ± 4.9 months). Among them, 19 patients (38%) showed an increase in LVEF to values &gt; 35% at follow up and a significant improvement in LVEF was appreciated (baseline LVEF: 31.2 ± 4.5 vs. follow up LVEF: 35.4 ± 8.0; p 0.003). No significant differences were recorded at baseline in LVEF within HF etiology and gender groups. At follow up, we found a significant increase in post-therapy LVEF only in the non-ischemic etiology group (from 31.5 ± 4.4 to 37.1 ± 8.1, p = 0.001) and in the male group (from 31.4 ± 4.5 to 34.9 ± 7.9, p = 0.005) in comparison with the ischemic etiology and the female group, respectively. No significant statistical differences were appreciated between responders and non-responders neither in terms of home medications nor in the LCZ696 doses, both at baseline and follow up.

Conclusion

This study suggests a potential impact of angiotensin receptor-neprilysin inhibition therapy in the selection of patients with HFrEF candidates to ICD in primary prevention. In this real-world experience from our HF clinic, we found a significant LVEF improvement in approximately 40% of patients treated with LCZ696. These patients, in FU evaluation, would not have needed for an ICD implantation. This benefit appears related to the non-ischemic etiology of HF and the male gender.

Abstract Figure. LVEF VARIATIONS

An extraordinary role for village community development workers in diagnosing blindness in the community

OBJECTIVE

To determine the reliability of village community development workers in screening for blindness in the community and to suggest an extraordinary role for these cadres.

DESIGN

Diagnostic study.

SETTING

Chivi District, Zimbabwe.

SUBJECTS

A simple random sample of 148 out of 886 people selected from notification forms.

MAIN OUTCOME MEASURE

Sensitivity, specificity and predictive values.

RESULTS

The screening method employed was found to have a sensitivity of 93% (95% CI), specificity of 32% (95% CI) and a predictive value for a positive result of 75%.

CONCLUSION

The use of village community development workers to screen for blindness in the community has proved to be a reliable alternative when there is shortage of both ophthalmic trained personnel and funds.