| Title: |
ACUTE AND PROLONGED EFFECT OF NEW TREATMENTS (LEVOSIMENDAN AND SACUBITRIL/VALSARTAN) IN HEART FAILURE: AN HOLISTIC EVALUATION |
| Authors: |
SPADAFORA, EMANUELE |
| Contributors: |
tutor: D. Baldassare; co-tutor: P. Agostoni; coordinatore: A.L. Catapano; E. Spadafora; BALDASSARRE, DAMIANO; CATAPANO, ALBERICO LUIGI |
| Publisher Information: |
Università degli Studi di Milano |
| Publication Year: |
2019 |
| Collection: |
The University of Milan: Archivio Istituzionale della Ricerca (AIR) |
| Subject Terms: |
heart failure; Settore BIO/14 - Farmacologia |
| Description: |
Alveolar-capillary membrane evaluated by carbon monoxide diffusion (DLCO) plays an important role in heart failure (HF). Surfactant Proteins (SPs) have also been suggested as a worthwhile marker. In acute HF, Levosimendan improves pulmonary hemodynamics and reduces lung fluids but associated SPs and DLCO changes are unknown. Sixty-five acute HF patients underwent spirometry, cardiopulmonary exercise test (CPET) and SPs determination before and after Levosimendan. Levosimendan caused natriuretic peptide-B (BNP) reduction, peakVO2 increase and VE/VCO2 slope reduction. Spirometry improved but DLCO did not. SP-A, SP-D and immature SP-B reduced (73.7 ± 25.3 vs. 66.3 ± 22.7 ng/mL*, 247 ± 121 vs. 223 ± 110 ng/mL*, 39.4 ± 18.7 vs. 34.4 ± 17.9AU*, respectively); while mature SP-B increased (424 ± 218 vs. 461 ± 243 ng/mL, * = p < 0.001). Spirometry, BNP and CPET changes suggest hemodynamic improvement and lung fluid reduction. SP-A, SP-D and immature SP-B reduction indicates a reduction of inflammatory stress; conversely mature SP-B increase suggests alveolar cell function restoration. In conclusion, acute lung fluid reduction is associated with SPs but not DLCO changes. SPs are fast responders to alveolar-capillary membrane condition changes. On the other hand, regarding chronic heart failure, Sacubitril/Valsartan represents a novel therapy in the treatment of chronic heart failure with reduced ejection fraction (HFrEF), has recently proved efficacy in improving exercise tolerance and cardiac performance. We enrolled a cohort of HFrEF outpatients eligible for sacubitril/valsartan and performed serial cardiopulmonary exercise tests (CPET), pulmonary function tests, laboratory and echocardiographic assessments before and during the gradual titration of this treatment, in order to evaluate its effects on cardiopulmonary function and left ventricular remodeling. In this interim analysis, we examined twenty-five patients treated with sacubitril/valsartan for at three months. At a mean follow-up of 169±74 days, 92% of ... |
| Document Type: |
doctoral or postdoctoral thesis |
| Language: |
English |
| Relation: |
https://hdl.handle.net/2434/695162 |
| DOI: |
10.13130/spadafora-emanuele_phd2019-12-11 |
| Availability: |
https://hdl.handle.net/2434/695162; https://doi.org/10.13130/spadafora-emanuele_phd2019-12-11 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.40B378BF |
| Database: |
BASE |