AimsTo assess the effect of angiotensin receptor blockers/neprilysin inhibitors (ARNI) on left ventricular (LV) ejection fraction (LVEF) and LV dimensions in a real-life cohort of heart failure and reduced ejection fraction (HFrEF) patients, while analysing patient characteristics that may predict reverse LV remodelling.
Methods and resultsThe ARNI-treated HFrEF patients followed at a single tertiary medical centre HF-outpatient clinic were included in the study. Clinical and echocardiographic parameters were evaluated prior to ARNI initiation, and while on ARNI therapy, assessing patient characteristics associated with reverse LV remodelling. The cohort included 91 patients (mean age 60.5 years, 90% male) and 47 (52%) patients exhibited ARNI responsiveness, defined as an increase in LVEF during therapy. Overall, LVEF increased by 19% post-ARNI (23.8 to 28.4%, P < 0.001). Subgroup analysis revealed several parameters associated with significant LVEF improvement, including baseline LVEF <30%, non-ischaemic HF aetiology, lack of cardiac resynchronization therapy (CRT), better initial functional class and ARNI initiation within 3 years from HF diagnosis (P ≤ 0.001 for all). Significant reduction in LV dimensions was noted in patients with lower initial LVEF, non-ischaemic HF and no CRT. Further combined subgrouping of the study population demonstrated that patients with both LVEF <30% and a non-ischaemic HF gained most benefit from ARNI with an average of 51% improvement in LVEF (19.9 to 30%, P < 0.001). Conclusions The ARNI treatment response is not uniform among HFrEF patient subgroups. More pronounce reverse LV remodelling is associated with early ARNI treatment initiation in the course of HFrEF, and in those with LVEF <30%, non-ischaemic HF and no CRT.
status. The patient became aphasic, began clenching her fists, and was shaking. A sodium level post-procedure was obtained and was 113. A head CT scan was performed and no central involvement was noted. The patient was managed with 3% hypertonic saline and her symptoms resolved. Over the next 2 days patient's sodium level normalized and the patient was discharged from the hospital. Discussion: This is the first reported case of hyponatremia secondary to water immersion endoscopy. While there is an abundance of reports describing hyponatremia in urologic and gynecologic procedures those procedures generally use glycine and mannitol as their irrigate. With regards to GI procedures, hyponatremia secondary to polyethylene glycol-electrolyte preparation has infrequently been reported. Free water irrigation/immersion is generally regarded as safe during gastroenterological procedures. Our case, brings awareness to the possibility of symptomatic hyponatremia following prolonged enteroscopy with the use of large volume water irrigation/immersion. Absorption of ingested water and most solutes occur in the proximal small intestine. If a large amount of fluids are necessary then normal saline can be utilized instead of water. Limiting water to 1.5 liters and suctioning excess water can help minimize these complications. Clinicians should be aware of this serious complication when performing these procedures.
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