DOI: 10.25881/BPNMSC.2021.69.28.031

Authors

Kol’cov A.V., YAlovec A.A., Kocoeva O.T., Kryukov E.V., Tyrenko V.V., Klimenko V.V.

S.M. Kirov Military medical academy, St. Petersburg

Abstract

A clinical case of treatment of a patient suffering from severe chronic heart failure is presented. The patient’s medical history lasts more than 20 years. All possible methods of treatment, both therapeutic and surgical, were used to save the patient’s life. The patient was implanted with modern mechanical devices to support the heart muscle, which allowed him to remain functional for almost ten years, while maintaining a relatively satisfactory quality of life. However, despite the treatment, there was a gradual deterioration in health over the past year, a sharp decrease in tolerance to physical activity, increased swelling, the patient was not able to self-care. In July 2019, the patient was examined at the Institute of Transplantology n.a. V.I. Shumakov (Moscow), recommended heart transplantation. In order to prepare the patient and eliminate the manifestations of heart failure, the patient was admitted to a cardiology hospital. At this stage, a modern combination of drugs (sacubitril/valsartan complex and empagliflozin) was selected, which not only stabilized the patient’s condition, but also helped to reduce the number of daily medications taken, without reducing the effectiveness of the main therapy, which allowed the patient to be included in the waiting list for heart transplantation.

Keywords: chronic heart failure, diabetes mellitus, ARNI, sacubitril / valsartan, mpagliflozin, Incor, sglt2, PARADIGM-HF, EMPA-REG.

References

1. Mareev VU, Fomin IV, Ageev FT, et al. Сlinical recommendations. Chronic heart failure. Heart failure. 2017; 18(1): 3–40. (In Russ).

2. McMurray JJ, Packer M, Desai AS, et al. Baseline characteristics and treatment of patients in Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF). Eur. J. Heart Fail. 2014; 16: 817–825.

3. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015; 373: 2117–2128.

4. McMurray J, Solomon S, Inzucchi S, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019; 381: 1995–2008. doi: 10.1056/NEJMoa1911303.

5. McMurray J, Ostergren J, Pfeffer M, et al. Clinical features and contemporary management of patients with low and preserved ejection fraction heart failure: baseline characteristics of patients in the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur J Heart Fail. 2003; 5 (3): 261–270.

6. Konstam MA, Neaton JD, Dickstein K et al. Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial. Lancet. 2009; 374(9704): 1840–1888.

7. CIBIS II Study Group. The Cardiac Insufficiency Bisoprolol Study II (CIBIS II): a randomized trial. Lancet. 1999; 353: 9–13.

8. Goldstein S, Fagerberg B, Hjalmarson A, et al. Metoprolol controlled release/extended release in patients with severe heart failure: analysis of the experience in the MERIT-HF study. J Am Coll Cardiol. 2001; 38(4): 932–8.

9. Swedberg K, Komajda M, Bоhm M, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 2010; 376(9744): 875–885.

10. Collier T, Pocock S, McMurray J, et al. The impact of eplerenone at different levels of risk in patients with systolic heart failure and mild symptoms: insight from a novel risk score for prognosis derived from the EMPHASIS-HF trial. Eur Heart J. 2013; 34: 2823–2829.

11. MacDonald MR, Petrie MC, Hawkins NM, et al. Diabetes, left ventricular systolic dysfunction, and chronic heart failure. Eur Heart J. 2008; 29(10): 1224–1240.

For citation

Kol’cov A.V., YAlovec A.A., Kocoeva O.T., Kryukov E.V., Tyrenko V.V., Klimenko V.V. Combined use of the first representative of ARNI (sacubitril/valsartan) in combination with empagliflozin in a patient with terminal chronic heart failure. Bulletin of Pirogov National Medical & Surgical Center. 2021;16(1):163-168. (In Russ.) https://doi.org/10.25881/BPNMSC.2021.69.28.031