PMID- 33738400
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220421
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 5
IP  - 2
DP  - 2021 Feb
TI  - The power of optimal medical therapy using angiotensin receptor-neprilysin 
      inhibitor in acute decompensated heart failure, sparing a critical patient 
      open-heart surgery with a device therapy: a case report.
PG  - ytaa530
LID - 10.1093/ehjcr/ytaa530 [doi]
LID - ytaa530
AB  - BACKGROUND: Timely use of Sacubitril/Valsartan has the potential to significantly 
      improve cardiac function and dramatically reduce secondary mitral regurgitation 
      (MR) severity even in patients presenting with acute decompensated heart failure 
      (HF), not only in compensated chronic HF patients. The outstanding impact of 
      echocardiography is obvious in monitoring improvement of cardiac function and MR 
      severity in patients with HF with reduced ejection fraction (HFrEF). CASE 
      SUMMARY: We report a relevant case of an elderly patient who presented with acute 
      decompensated HF and severe MR. He was symptomatic despite being on maximally 
      tolerated doses of ACEI, beta-blockers, and diuretics. Left ventricular ejection 
      fraction (LVEF) improved from 15% to 35% 2 weeks following initiation of 
      Sacubitril/Valsartan during second HF hospitalization. There was a dramatic 
      improvement of patient's symptoms from New York Heart Association (NYHA) Class IV 
      to NYHA I. N-terminal pro B-type natriuretic peptide reduced from 9000 pg/mL to 
      800 pg/mL. Coronary angiography depicted three-vessel coronary artery disease. 
      The patient was advised to undergo coronary artery bypass graft surgery with 
      mitral valve repair, then followed by implantation of a cardiac resynchronization 
      therapy-defibrillator device (CRT-D) if no LV function improvement is observed 
      after revascularization. The electrocardiogram showed Q waves in inferior leads 
      with QRSd >/= 125 ms, hence a good candidate for CRT. Following an elective 
      percutaneous coronary intervention, LVEF further improved to 50%. The patient 
      became asymptomatic with preserved LVEF on follow-up for 18 months later. 
      DISCUSSION: This case report documents the swift echocardiographic and symptom 
      improvement in a decompensated end-stage HF patient when Sacubitril/Valsartan 
      initiated during acute setting.
CI  - (c) The Author(s) 2020. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Gerges, Fady
AU  - Gerges F
AUID- ORCID: 0000-0002-8813-119X
AD  - Department of Cardiovascular Sciences, NMC Specialty Hospital, Cardiology Clinic, 
      Al Ain, Postal code P.O. Box 84142,United Arab Emirates.
FAU - Komaranchath, Austin
AU  - Komaranchath A
AD  - Department of Cardiovascular Sciences, NMC Specialty Hospital, Cardiology Clinic, 
      Al Ain, Postal code P.O. Box 84142,United Arab Emirates.
FAU - Al Bakshy, Faiz
AU  - Al Bakshy F
AUID- ORCID: 0000-0002-7464-1391
AD  - Department of Cardiology, Mediclinic Al-Ain hospital,United Arab Emirates.
FAU - Almaghraby, Abdallah
AU  - Almaghraby A
AD  - Department of Cardiology, University of Alexandria,Egypt.
LA  - eng
PT  - Case Reports
DEP - 20201229
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC7954393
OTO - NOTNLM
OT  - Angiotensin receptor-neprilysin inhibitor
OT  - CRT-D
OT  - Case report
OT  - Coronary artery disease
OT  - Echocardiography
OT  - NT-proBNP
OT  - Sacubitril/Valsartan
OT  - heart failure with reduced ejection fraction
EDAT- 2021/03/20 06:00
MHDA- 2021/03/20 06:01
PMCR- 2020/12/29
CRDT- 2021/03/19 07:28
PHST- 2020/06/09 00:00 [received]
PHST- 2020/07/28 00:00 [revised]
PHST- 2020/12/01 00:00 [accepted]
PHST- 2021/03/19 07:28 [entrez]
PHST- 2021/03/20 06:00 [pubmed]
PHST- 2021/03/20 06:01 [medline]
PHST- 2020/12/29 00:00 [pmc-release]
AID - ytaa530 [pii]
AID - 10.1093/ehjcr/ytaa530 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2020 Dec 29;5(2):ytaa530. doi: 10.1093/ehjcr/ytaa530. 
      eCollection 2021 Feb.