Objective: To evaluate if switching therapy from an angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) to sacubitril/valsartan induces incremental left ventricular (LV) reverse remodeling and the effect of switching on quality of life (QOL) in heart failure with reduced ejection fraction (HFrEF). Methodology: This prospective multicenter study included 100 patients with HFrEF. The patients were subdivided into two equal groups: Group one included patients who were switched to sacubitril/valsartan and group two included patients continued on ACEIs or ARBs as control group. The patients were subjected to medical history taking, clinical examination, heart failure related data, New York Heart Association (NYHA) functional classification, blood samples and chemistry, transthoracic echocardiography (TTE) and quality of life assessment. Results: There was marked improvement in all two dimensional (2D) echocardiography parameters, as left ventricular end-systolic volume (LVESVI), left ventricular end-diastolic volume index (LVEDVI) and left atrium volume index (LAVI) which significantly reduced after 3 months of therapy with significant improvement in LV function (P-value < 0.05). Moreover, mitral regurgitation (MR) severity significantly decreased (P-value < 0.05). Regarding quality of life, there was a significant improvement in QOL. KCCQ score was significantly improved after 3 months of treatment (P-value < 0.05). Conclusion: In HFrEF patients, sacubitril/valsartan significantly improves LV function; furthermore, it induces incremental LV reverse remodeling as well as improves QOL.
Background: Unnecessaryright ventricular (RV) pacing leads to cardiac dyssynchrony and increases the risk of developing permanent atrial fibrillation. Minimizing RV pacing by specefic algorithms decreases the AF risk. Aim and objectives: Our objective was to study the effect of pacemaker algorithms on atrial fibrillation progression. Subjects and Methods: Patients with dual chamber (group A) and single chamber (group B)pacemakers were included in the study. Patients with history of AF at the time of pacemaker implantation were not included in the study. The relation between pacemaker parameters and AF development was monitored. Result: Group A showed that RV pacing percentage had high significance for developing AF with P value P <0.001, also A pacing had high significance for developing AF with P value <0.001 and VIP mode OFF there was high significance of developing AF with P value <0.001.As regards group B RV pacing (%) had high significant risk for developing AF with p value<0.001,Also hysteresis off had high significant risk for developing AF with p value<0.005. Conclusion: Reducing unnecessary RV pacing in single and dual chamber pacemakers is assossiated with decreasing the risk of AF.
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