Thursday , August 5 2021

HF treatment after cardiomyopathy healing increases the risk of relapse



According to the data presented in the CHICAGO – American Heart Association Scientific Sessions, approximately half of the patients who were withdrawn from pharmacological HF treatment and were recovered from dilated cardiomyopathy recurred.

Iy The discontinuation of treatment should not be recommended to our patients until we can at least predict who will be relapsed, and we should be able to better understand the treatments and the importance of different treatments, “ Brian Halliday, MBChB, PhDShe said during a press conference she was a clinical lecturer in cardiology at Imperial College in London.

The investigators analyzed data covering 63 patients with pre-dilated cardiomyopathy who were recovered and who received at least one drug. A screening visit was conducted prior to randomization for clinical evaluation, symptom questionnaires, cardiac MRI, N-terminal pro-B-type natriuretic peptide measurement, and cardiopulmonary exercise test.

Patients were given either discontinuation of treatment (n = 25; median age, 54 years; 64% male) or ongoing treatment (n = 26; median age, 56 years; 69% male). Drugs including loop diuretics (12%), mineraocorticoid receptor antagonists (47%), beta-blockers (88%), and angiotensin converting enzyme inhibitors (100%) were reduced and then discontinued in patients in the withdrawal group.

Patients in the withdrawal group underwent a clinical review every 4 weeks and patients in the ongoing treatment group had a clinical visit every 8 weeks. Follow-up visits were made in 16 weeks and 6 months. After 6 months, the patients in the control arm were withdrawn from treatment with the same protocol as the patients initially assigned for withdrawal.

The primary endpoint was greater than 10% in the left ventricular ejection fraction and less than 50% in the left ventricular ejection fraction, more than 10% in the LV end-diastolic volume, and in the two-fold increase in NT above the normal range. was the recurrence of dilated cardiomyopathy. pro-BNP and 400 ng / L or clinical evidence of HF. When the primary end point was met, the treatment was immediately resumed.

The primary endpoint was compared with the absence in the control group at 44% of the absence in the treatment group. At the crossing stage, the primary endpoint was seen in 36% of patients. In all patients starting to withdraw (n = 50), the primary end point was 40%, while 50% of the patients completed the follow-up without resuming treatment. LVEF did not deteriorate in 32% of the patients who had completed the procedure.

The safety endpoint was significant adverse CV events, CV mortality, and unplanned CV hospitalization. There were no unplanned HF deaths, deaths or major adverse CV events during follow-up. In patients with withdrawal, three serious side effects occurred, including non-cardiac chest pain, urine sepsis and hospitalization for an elective procedure. There were also no continuous ventricular arrhythmias or device therapies. Atrial fibrillation occurred in three patients. All patients with a primary endpoint were asymptomatic at follow-up.

Iy The improvement in the function shows a decline, rather than a permanent recovery for many patients, iyor Halliday told a press conference.

Or This trial does not silence the idea of ​​myocardial healing “ Jane E. Wilcox, MD, MSc, Northwest University Feinberg School of Medicine (cardiology) assistant professor, said in the argumentative section of the press conference. Orum In fact, I think that this area will address the genomic, proteomics and metabolomics of deepening and healing. The evaluation of myocardial substrate is the key and the signals in cardiac mechanics are real, but require strict standardization. "

Clyde W. Yancy

This work is published simultaneously Lancet and an editorial included.

Ilaç In response to a patient's question: i Now that my heart failure has improved, can I stop my heart failure medications? Co The answer should be, dır No, not right now. Abı ”Wilcox and Clyde W. Yancy, MD, MSc, He was the Vice Dean of the Faculty of Medicine, Magerstadt Professor of Medicine and Professor of Medical Sciences at Feinberg School of Medicine in Feinberg School of Medicine and former Past President of AHA, Associate Editor. Ere Since these patients are fortunate enough to improve ventricular function and improve the clinical syndrome of heart failure, we must continue effective treatments indefinitely. “ – by Darlene Dobkowski

References:

Halliday B, et al. LBS.05 – Hot News in HF. Presented in: American Heart Association Scientific Sessions; November 10, 2018; Chicago.

Halliday B, et al. lancet. 2018; doi: 10.1016 / S0140-6736 (18) 32.484-X.

Wilcox JE, et al. lancet. 2018; doi: 10.1016 / S0140-6736 (18) 32.825-3.

disclosures: Halliday, Wilcox and Yancy do not report the relevant financial statements.

According to the data presented in the CHICAGO – American Heart Association Scientific Sessions, approximately half of the patients who were withdrawn from pharmacological HF treatment and were recovered from dilated cardiomyopathy recurred.

Iy The discontinuation of treatment should not be recommended to our patients until we can at least predict who will be relapsed, and we should be able to better understand the treatments and the importance of different treatments, “ Brian Halliday, MBChB, PhDShe said during a press conference she was a clinical lecturer in cardiology at Imperial College in London.

The investigators analyzed data covering 63 patients with pre-dilated cardiomyopathy who were recovered and who received at least one drug. A screening visit was conducted prior to randomization for clinical evaluation, symptom questionnaires, cardiac MRI, N-terminal pro-B-type natriuretic peptide measurement, and cardiopulmonary exercise test.

Patients were given either discontinuation of treatment (n = 25; median age, 54 years; 64% male) or ongoing treatment (n = 26; median age, 56 years; 69% male). Drugs including loop diuretics (12%), mineraocorticoid receptor antagonists (47%), beta-blockers (88%), and angiotensin converting enzyme inhibitors (100%) were reduced and then discontinued in patients in the withdrawal group.

Patients in the withdrawal group underwent a clinical review every 4 weeks and patients in the ongoing treatment group had a clinical visit every 8 weeks. Follow-up visits were made in 16 weeks and 6 months. After 6 months, the patients in the control arm were withdrawn from treatment with the same protocol as the patients initially assigned for withdrawal.

The primary endpoint was greater than 10% in the left ventricular ejection fraction and less than 50% in the left ventricular ejection fraction, more than 10% in the LV end-diastolic volume, and in the two-fold increase in NT above the normal range. was the recurrence of dilated cardiomyopathy. pro-BNP and 400 ng / L or clinical evidence of HF. When the primary end point was met, the treatment was immediately resumed.

The primary endpoint was compared with the absence in the control group at 44% of the absence in the treatment group. At the crossing stage, the primary endpoint was seen in 36% of patients. In all patients starting to withdraw (n = 50), the primary end point was 40%, while 50% of the patients completed the follow-up without resuming treatment. LVEF did not deteriorate in 32% of the patients who had completed the procedure.

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The safety endpoint was significant adverse CV events, CV mortality, and unplanned CV hospitalization. There were no unplanned HF deaths, deaths or major adverse CV events during follow-up. In patients with withdrawal, three serious side effects occurred, including non-cardiac chest pain, urine sepsis and hospitalization for an elective procedure. There were also no continuous ventricular arrhythmias or device therapies. Atrial fibrillation occurred in three patients. All patients with a primary endpoint were asymptomatic at follow-up.

Iy The improvement in the function shows a decline, rather than a permanent recovery for many patients, iyor Halliday told a press conference.

Or This trial does not silence the idea of ​​myocardial healing “ Jane E. Wilcox, MD, MSc, Northwest University Feinberg School of Medicine (cardiology) assistant professor, said in the argumentative section of the press conference. Orum In fact, I think that this area will address the genomic, proteomics and metabolomics of deepening and healing. The evaluation of myocardial substrate is the key and the signals in cardiac mechanics are real, but require strict standardization. "

Clyde W. Yancy

This work is published simultaneously Lancet and an editorial included.

Ilaç In response to a patient's question: i Now that my heart failure has improved, can I stop my heart failure medications? Co The answer should be, dır No, not right now. Abı ”Wilcox and Clyde W. Yancy, MD, MSc, He was the Vice Dean of the Faculty of Medicine, Magerstadt Professor of Medicine and Professor of Medical Sciences at Feinberg School of Medicine in Feinberg School of Medicine and former Past President of AHA, Associate Editor. Ere Since these patients are fortunate enough to improve ventricular function and improve the clinical syndrome of heart failure, we must continue effective treatments indefinitely. “ – by Darlene Dobkowski

References:

Halliday B, et al. LBS.05 – Hot News in HF. Presented in: American Heart Association Scientific Sessions; November 10, 2018; Chicago.

Halliday B, et al. lancet. 2018; doi: 10.1016 / S0140-6736 (18) 32.484-X.

Wilcox JE, et al. lancet. 2018; doi: 10.1016 / S0140-6736 (18) 32.825-3.

disclosures: Halliday, Wilcox and Yancy do not report the relevant financial statements.


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