Objective: Determination the evolution of structural and functional parameters of the heart to the patient with systolic heart failure after treatment with ARNI.
Methods: 50-year-old man, overweight, smoker, was admited for dyspnoea to minimal physical activity, nocturnal paroxysmal dyspnoea, heart palpitations, ankles edema, fatigue. For 17-year he has hypertension with increases in blood pressure up to 240/160 mmHg, installed after acute Glomerulonephritis. He has atrial fibrillation for 16 years, and in 2015 he suffered a cardi-oembolic stroke in the right mean cerebral artery. The laboratory tests revealed only elevations in serum urate levels – 15.8 mmol / L, serum creatinine – 254 mkmol L and NT-pro BNP-1400 pg / ml. Echocardiography: severe dilation RA-50 mm, RV-37 mm, LV (LVDd-65 mm, LVDs-59 mm), moderate LA-44 mm with severe reduction of EF LV-25%, hypertrophy IVS (16 mm) and posterior wall (13 mm), elevation SPAP-64 mmHg), fluid in the pericardium cavity up to 21 mm at apex. Examining X-Ro: Accentuated pulmonary design, ve-nous stasis, bilateral pleural effusion.
Results: Patient discharged at home with beta blockers (Carvedilol 12.5 mg x 2 times daily), oral anticoagulants (Warfarin 3 mg in the evening), loop diuretics (Torase-mid 10 mg daily), antialdosteronics (Spironolactone 50 mg in the morning), calcium antagonists (Lercanidipi-ne 10 mg x 2 times / day) and ARNI (Sacubitril/Val-sartan 50 mg x 2 times/day, then increasing the dose to 200 mg x 2 times). After 6 months, an apparent clinical improvement is visible through the presence of inspi-ratory dyspnea only at moderate effort, increased effort tolerance, lack of ankle edema. There was a reduction in the level of NT-pro BNP at 500 μg / ml. Echocardi-ography: LV reduction (LVDd-60 mm, LVDs-49 mm), increased LV EF up to 40%, reduction SPAP-50 mmHg and fluid in pericardium cavity up to 8 mm at RA.
Conclusions: Treatment with ARNI has reduced the symptoms of heart failure and improved structural and functional parameters of the heart.