P687Is sacubitril/valsartan useful in patients with cancer and heart failure? Data from HF-COH Spanish multicenter registry

Abstract Current guidelines recommend sacubitril/valsartan (S/V) for patients (p.) with heart failure and reduced left ventricular ejection fraction (LVEF) but there is lack of evidence of its efficacy and safety in p. with cancer and heart failure. Our aim was to analyze the potential benefit of S/V in specific cardio-oncology clinics. Methods We performed a retrospective multicenter registry (HF-COH) in six Spanish hospitals with cardio-oncology clinics including all p. treated with S/V. Clinical and echocardiographic data, NYHA functional class, type of neoplasms and anti-tumoral treatment were described. Median follow-up was 7.2 [7.9] months. Results Sixty-one p. were included (median age was 64 [21] years old; 64%women, 43% hypertensive, 54% dyslipidemics and 28% diabetics). Most of p. (97%) had cancer therapy related cardiac dysfunction (CTRD) with a median time from anti-cancer therapy to CTRD of 40 [132] months. Breast (46%) and hematological (38%) cancers were the most frequent neoplasms, 31% of p. had metastatic disease and 71% had been treated with anthracyclines. In 5% S/V was initiated at CTRCD diagnosis while in 95% S/V was started to improve clinical status in p. already treated with ACE inhibitors or ARBs. 87% were on beta-blocker therapy and 74% on mineralocorticoid receptor antagonists.Maximal S/V titration dose was achieved in 8.2% of p. (24/26mg: 43%; 49/51mg: 33%) S/V was discontinued in 4 p. (reasons: 2 hypotension; 1: renal failure; 1: pruritus) Baseline NT-proBNP levels, functional class, and LVEF improved at the end of follow-up in p. who continued with S/V (all p values ≤0.01). No statistical differences were found in creatinine clearance or potassium serum levels. Table Patient parameters before and after S/V Before S/V After S/V P value LVEF (%) 33 [7] 39.5 [15] &lt;0.001 Creatinine (mg/dl) 0.9 [0.4] 0.9 [0.5] 0.15 Creatinine clearance (ml/min) 73 [30] 75 [37] 0.22 Potassium serum levels (mg/dl) 4.5 [0.5] 4.5 [0.6] 0.42 Systolic arterial pressure (mmHg) 116 [23] 112 [27] 0.025 Diastolic arterial pressure (mmHg) 70 [13] 68 [10] 0.498 NT-proBNP (pg/ml) 1831 [3132] 842 [1919] 0.007 NYHA 2.2±0.6 1.6±0.62 &lt;0.001 Values are median [interquartile range] or mean ± standard derivation; S/V: sacubitril-valsartan; LVEF: left ventricle ejection fraction. Conclusions Our experience suggests that S/V is well tolerated and improves functional class and left ventricular function parameters in patients with CTRCD. </jats:sec

Particle size and cholesterol content of circulating HDL correlate with cardiovascular death in chronic heart failure

AbstractEvidence regarding any association of HDL-particle (HDL-P) derangements and HDL-cholesterol content with cardiovascular (CV) death in chronic heart failure (HF) is lacking. To investigate the prognostic value of HDL-P size (HDL-Sz) and the number of cholesterol molecules per HDL-P for CV death in HF patients. Outpatient chronic HF patients were enrolled. Baseline HDL-P number, subfractions and HDL-Sz were measured using 1H-NMR spectroscopy. The HDL-C/P ratio was calculated as HDL-cholesterol over HDL-P. Endpoint was CV death, with non-CV death as the competing event. 422 patients were included and followed-up during a median of 4.1 (0–8) years. CV death occurred in 120 (30.5%) patients. Mean HDL-Sz was higher in CV dead as compared with survivors (8.39 nm vs. 8.31 nm, p &lt; 0.001). This change in size was due to a reduction in the percentage of small HDL-P (54.6% vs. 60% for CV-death vs. alive; p &lt; 0.001). HDL-C/P ratio was higher in the CV-death group (51.0 vs. 48.3, p &lt; 0.001). HDL-Sz and HDL-C/P ratio were significantly associated with CV death after multivariable regression analysis (HR 1.22 [95% CI 1.01–1.47], p = 0.041 and HR 1.04 [95% CI 1.01–1.07], p = 0.008 respectively). HDL-Sz and HDL-C/P ratio are independent predictors of CV death in chronic HF patients.</jats:p

Temporal variation of bird assemblages in a wetland: influence of spatial heterogeneity

The temporal variation of bird assemblages at three sites within a wetland of the Parana River was examined. The aim was to obtain an overview of the influence of spatial heterogeneity on communities in such a variable environment as the wetlands. We recorded 1,662 individuals belonging to 139 species from 40 families. There were no significant differences between sites in richness, abundance nor diversity. Species richness in the first year was greater than during the second year. Number of resident and migrant species decreased in the second year. Community composition differed between the two years of study and was significantly different among seasons. Species were grouped into 19 trophic guilds. In this study, number of species and their abundances were not significantly different among sites; there were differences in the composition of birds among sites. Thus, the structure of the environments influenced the composition of assemblages in different areas. Guild composition remained fairly constant between years and among seasons. Geomorphological and hydrological dynamics of the river produce a heterogeneous availability of habitats and resources that affect the composition of bird assemblages. Annual and seasonal changes in meteorological variables can lead to changes in the structure and/or composition of those assemblages.Fil: Ronchi Virgolini, Ana Laura. Universidad Autónoma de Entre Ríos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Lorenzón, Rodrigo Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto Nacional de Limnología. Universidad Nacional del Litoral. Instituto Nacional de Limnología; ArgentinaFil: Blake, John G.. University of Florida; Estados UnidosFil: Beltzer, Adolfo Hector. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto Nacional de Limnología. Universidad Nacional del Litoral. Instituto Nacional de Limnología; Argentin