P777Changes in glycated hemoglobin in patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan

Introduction

Glycemic control reflected by glycated hemoglobin (HbA1c) is regarded as a risk factor and a strong predictor of mortality in patients with heart failure (HF). Hyperglycemia may contribute to oxidative stress, endotelial dysfunction and cardiac fibrosis and influence negatively heart failure prognosis in patients with or without diabetes. Treatment with neprilysin inhibitors in combination with angiotensin II receptor antagonist,(ARNIs) has shown beneficial effects in morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF).

Purpose

We sought to investigate eventual reductions in HbA1c in patients receiving the novel therapy.

Methods

We enrolled a total of 52 stable patients with HFrEF eligible for treatment with ARNIs. Patients were administered a target dose of 200mg bid (97mg sacubitril/103mg valsartan) and we measured HbA1c before, 3months and 6months after initiation of therapy. Changes in HbA1c levels were tested with General Linear Model Repeated Measures test. Spearmans' Rho correlation analysis was performed to investigate possible relationship between the above.

Results

Mean age was 62±10 years, 69,2% of patients were on New York Heart Association (NYHA) functional class II, 23,1% on NYHA III and 7,7% on NYHA IV. 57,7% had ischemic while 42,3% dilated cardiomyopathy, 25% chronic kidney disease and 38,5% diabetes mellitus. Mean Body Mass Index (BMI) was 29,88±4,66 kg/m2. Median value of baseline HbA1c was 5,8% (IQR 0,9). Compared to baseline values, HbA1c decreased to 5,6 (IQR 0,9) and 5,7 (IQR 0,83) (p=0,012) at three and six months of treatment, respectively. Change in HbA1c levels was associated significantly with the presence of diabetes mellitus (p=0,013) and diabetic patients showed greater relative reduction in HbA1c (8%) compared to non diabetic patients (1%). Spearmans' Rho test revealed statistically significant association between changes in HbA1c levels from initiation to three months of therapy, while changes between initiation to six months of administration did non correlate with the presence of diabetes.

Changes in HbA1c

Conclusions

HbA1c levels were reduced significantly during treatment with sacubitril/valsartan. Changes were independent of diabetes in six months of treatment.

P6596S100A8/A9 and sRAGE peripheral blood levels in patients with heart failure and an implanted cardioverter/defibrillator: relation with sustained, fast ventricular arrhythmias

Background

Prediction of sudden cardiac death in heart failure (HF) remains suboptimal. Blood levels of the S100A8/A9 heterodimer protein complex and the soluble receptor of advanced glucation end product (sRAGE) are promising biomarkers in HF, reflecting inflammatory/fibrotic and apoptotic pathways, possibly involved in ventricular arrhythmogenesis. The relation of S100A8/A9 and sRAGE with ventricular arrhythmias and sudden cardiac death risk has not been previously assessed.

Purpose

Purpose of the study was to investigate whether S100A8/A9 and sRAGE serum blood levels of patients (pts) with systolic heart failure are related to the occurrence of life-threatening ventricular tachyarrhythmias.

Patients and methods

We studied 60 pts with clinically stable heart failure due to coronary artery disease (n=37) and dilated cardiomyopathy (n=23), all with a chronically implanted ICD for primary (n=43) or secondary (n=16) sudden death prevention, all in sinus rhythm. Their mean age (±1 SE) was 62±2 years, NYHA class I-II, mean LVEF 28±1%, Nt-pro-BNP 893±85 pg/dl. Blood was drawn at study initiation for S100A8/A9 and sRAGE assessment (ELISA, R&D Systems). They all were systematically followed-up for 4 years regarding the occurrence of fast ventricular tachyarrhythmias (>180 bpm) necessitating antiarrhythmic intervention through the ICD.

Results

S100A8/A9 and sRAGE levels were 16±1.6 ng/ml and 1076±99 pg/ml respectively. S100A8/A9 levels were lower than in normal controls, while sRAGE levels were within normal limits. During the 4-year follow-up period, 39 pts had an uneventful course (Group I), while 16 pts exhibited fast ventricular tachyarrhythmic episodes necessitating ICD activation (anti-tachycardia pacing or shock, Group II). Three pts died of pump failure and 2 pts of non-cardiac causes. No differences were observed between Group I and Group II pts regarding mean NYHA class, Nt-pro-BNP levels. Group II patients had significantly lower LVEF as well as S100A8/A9 serum levels relative to pts without ventricular arrhythmias (LVEF: 30±1.2 vs, 25±1.3%, p<0.05, S1OOA8/A9: 18.9±2.2 vs 11.8±1.5 ng/ml, p<0.05), while no difference was observed between Groups regarding sRAGE levels 1097±101 1105±239 pg/ml, p:NS). S100A8/A9 levels were not related significantly to LVEF (r:-21, p=0.13).

Conclusion

S100A8/A9 protein levels are reduced in pts with stable HF and an implanted ICD. They are even lower among pts with rapid ventricular tachyarrhythmias occurring during follow-up. This finding implies that S100A8/A9 may constitute a biomarker of increased sudden cardiac death risk in HF, in addition to reduced LVEF.

Head-up tilt test with clomipramine challenge in vasovagal syndrome--a new tilt testing protocol

PURPOSE

The aim of the study was to randomly compare clomipramine, used as a challenge-agent during head-up tilt test, with isoproterenol, used in the conventional test, in patients with vasovagal syndrome.

SUBJECTS AND METHODS

The serotonergic re-uptake inhibitor clomipramine was infused (5mg in 5min) at the start of head-up tilt test (Clom-HUT) in 126 patients (mean age 41+/-16 years) with positive history of recurrent neurocardiogenic syncope, and in 54 healthy control subjects (mean age 46+/-15 years). All subjects had also been tested with a conventional 60 degrees head-up tilt test (Con-HUT) for 30 min and, if negative, isoproterenol infusion was performed at the end of the test. The two tests were performed in a random order with a 24-h interval between them.

RESULTS

Fifty-two of the 126 patients (41%) and two of the 54 controls had a positive response to Con-HUT. In the Clom-HUT the proportion of patients who experienced a positive response increased to 83% (105 subjects), while this happened only to four control subjects. The predictive accuracy of Clom-HUT increased compared to Con-HUT from 58 to 86%, respectively.

CONCLUSION

The results indicate an increased responsiveness of central serotonergic neural system in subjects with vasovagal syndrome, the activation of which leads to sympathetic withdrawal. The use of clomipramine infusion during tilt test seems to improve considerably its diagnostic value.