Background Sacubitril/valsartan has been shown to significantly reduce cardiovascular mortality and hospitalizations due to heart failure in adult patients with reduced ejection fraction when compared to enalapril. To the best of our knowledge, the combination of sacubitril (neprilysin inhibitor) and valsartan (angiotensin receptor blocker) has not been evaluated in patients with chemotherapy-induced cardiomyopathy, as these patients were excluded from the recent pivotal trial, PARADIGM-HF. However, current guidelines for the evaluation and management of cardiovascular complications of cancer therapy, published by the Canadian Cardiovascular Society, direct clinicians to the Canadian Cardiovascular Society Heart Failure Guidelines for the management of cancer patients who develop clinical heart failure or an asymptomatic decline in left ventricular ejection fraction (e.g. >10% reduction from baseline or left ventricular ejection fraction <53%), which could include the use of sacubitril/valsartan. Methods Retrospective descriptive comparative case study of two patients treated with sacubitril/valsartan. Results We present data from two patients who experienced anthracycline-induced cardiomyopathy and were successfully managed with sacubitril/valsartan after suboptimal responses to traditional evidence-based heart failure therapies. Both patients demonstrated some recovery of function and normalization of N-terminal pro B-type natriuretic peptide levels. Sacubitril/valsartan was well tolerated with minimal side effects. To date, neither patient has required hospitalization or additional clinic interventions for heart failure. Conclusions While further large scale studies are required to determine a comprehensive safety and efficacy profile, we report two cases of anthracycline-induced cardiomyopathy survivors managed with sacubitril/valsartan with minimal side effects and no hospitalizations.
BackgroundAlthough the number of lung transplantations (LTx) performed worldwide for COVID-19 induced acute respiratory distress syndrome (ARDS) is still low, there is general agreement that this treatment can save a subgroup of most severly ill patients with irreversible lung damage. However, the true proportion of patients eligible for LTx, the overall outcome and the impact of LTx to the pandemic are unknown.MethodsA retrospective analysis was performed using a nationwide registry of hospitalised patients with confirmed severe acute respiratory syndrome coronavirus type 2 (SARS-Cov-2) infection admitted between January 1, 2020 and May 30, 2021 in Austria. Patients referred to one of the two Austrian LTx centers were analyzed and grouped into patients accepted and rejected for LTx. Detailed outcome analysis was performed for all patients who received a LTx for post-COVID-19 ARDS and compared to patients who underwent LTx for other indications.ResultsBetween January 1, 2020 and May 30, 2021, 39.485 patients were hospitalised for COVID-19 in Austria. 2323 required mechanical ventilation, 183 received extra-corporeal membrane oxygenation (ECMO) support. 106 patients with severe COVID-19 ARDS were referred for LTx. Of these, 19 (18%) underwent LTx. 30-day mortality after LTx was 0% for COVID-19 ARDS transplant recipients. With a median follow-up of 134 (47–450) days, 14/19 patients are alive.ConclusionsEarly referral of ECMO patients to a LTx center is pivotal in order to select patients eligible for LTx. Transplantation offers excellent midterm outcomes and should be incorporated in the treatment algorithm of post-COVID-19 ARDS.
Clinical Nutrition Experimental 32 (2020) 38e73 validity. The subject's position, the location of the measuring points, the performance and evaluation of the ultrasound scans are discussed and compared to other published ultrasound methodologies.
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