S.QUEK1, IKK CHUNG1, LX CHAN1
Tan Tock Seng Hospital1
To compare the effect of switching treatment with S/V from ACE-I or angiotensin receptor antagonists (ARB) in patients with severe left ventricular systolic dysfunction on reverse LV remodelling and renal function.
Patients with left ventricular ejection fraction(EF) < 40% and NYHA II-IV were switched from ACE-I/ARB to S/V at maximum tolerated dose in addition to beta-blockers and aldosterone antagonists.
LV reverse remodelling was evaluated with an echocardiogram using EF measurement by Simpson’s biplane method at baseline and after mean duration of 290 days with S/V treatment. A surrogate of the patient’s renal function was measured by Creatine levels (µmol/l).
Total of 167 patients. 122 (73%) males, mean age 62.7 ± 12.4 years treated with of S/V of 96 mg. 45% of patients had ischaemic aetiology, 69% hypertension, 50% diabetes mellitus and 25% atrial fibrillation.
Improved LVEF from 24.81 ± 8.88 to 32.98 ± 13.67 % seen after switching medical therapy from ACE-I/ARB to S/V (P<0.001).
LVEF increased from 25.60% ± 8.24 to 30.57% ± 11.87 and from 24.14% ± 9.38 to 34.79% ± 14.63 in the ischaemic and non-ischaemic cardiomyopathy but was not significant. Creatine levels improved from 103.62 ± 33.89 to 98.86 ± 32.88 µmol/l (p<0.001).
A statistical significance in LV reverse remodelling and improvement in renal function after switching from standard therapy ACE-I/ARB to S/V. Showing clinical benefits of S/V over ACE-I/ARB.
Optimal therapy for heart failure patients shouldinclude S/V therapy prior to the assessment and consideration for device therapy in the primary prevention for sudden cardiac death.