373
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Sun-163￭
Clinical role of sacubitril/valsartan in heart failure with reduced ejection fraction with ESRD
연세대학교 의과대학 신촌 세브란스 병원 내과학 교실
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이선화 , 오재원, 하재형, 전경현, 김효은, 이찬주, 박성하 , 이상학, 강석민
Background/Aims: Sacubitril/valsartan (SV) reduced heart failure hospitalization and cardiovascular mortality compared to enalapril in the PARADIGM-HF trial. However, this trial excluded patients with end stage of renal disease (ESRD), thus the efficacy and safety of SV in heart failure with reduced ejection fraction (HFrEF) with ESRD remains uncertain. Methods: We retrospectively analyzed the clinical and laboratory data of 501 HFrEF pa- tients who administered with SV from Mar 2017 to April 2019 in a single tertiary university hospital. Results: A total of 20 HFrEF patients with ESRD on dialysis (60±17 years old, 85% male, 60% non-ischemic cardiomyopathy, left ventricular ejection fraction (LVEF); 29.7±4.4%) were included in this study.
All patients were switched from ACE-I/ARB to SV, on top of guideline-directed medical therapy. The mean dose of SV was 90.0±43.0 mg/day at baseline and 122.5±62.3 mg/day at last follow-up (follow-up duration: median 132, interquartile range of 77-132 days). The level of high-sensitive Troponin-T (hsTnT) was significantly reduced from 236.2±355.3 to 97.0±14.0 pg/mL (p=0.002), LVEF was significantly improved from 29.7±4.4 to 40.8±10.4%
(p=0.002). During the follow-up, up-titration, down-titration, and maintenance of SV dosing were observed in 6 (30%), 4 (20%), and 10 patients (50%), respectively. SV down-titration group had adverse events including symptomatic hypotension (SBP <100mmHg) (n=3) and dizziness (n=1). However, there was no significant difference in systolic blood pressure between baseline and last follow-up (126±16mmHg vs. 121±19mmHg, p=0.269). During follow-up, there were only 2 (10%) heart failure hospitalizations without cardiovascular mortality in our study population. Conclusions: This is the first study to show the efficacy and safety of SV in HFrEF with ESRD on dialysis. Larger prospective, long term follow-up study should be warranted.
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Sun-164￭
Reperfusion and drug therapy of recurrent myocardial infarction in a patient with Kawasaki disease
제주대학교 의과대학 내과학교실
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조대홍, 범종욱, 김송이
Kawasaki disease is a systemic vasculitis of unknown etiology and its clinical course is self-limited, but it induces inflammation in medium-sized muscular arteries and, though rare, coronary artery aneurysm. Coronary artery aneurysm increases the risk of formation of blood clots, and thrombotic occlusion of coronary artery lumina may cause fatal ischaemic heart disease. We performed reperfusion and drug therapy for the treatment of aneurysmal dilatation of coronary arteries and a total occlusion of right coronary artery, which appeared to be a sequela of Kawasaki disease, in a 55-year-old man, who had had two previous myocardial infarctions and was being treated with antithrombotic agents and anticoagulants. We report that this therapy - ballon angioplasty, thrombosuction, and antiplatelet and anticoagulant therapy using abciximab and enoxaparin – can be an effective treatment method for myocardial in- farction developing as a complication of Kawasaki disease.
