lo mejor del acc 2014. insuficiencia cardiaca, hta y pericardio

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ACC 14 WashingtonTomás Ripoll

Almudena CastroAntoni MartinezAlfonso Varela

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MADIT LTFU Long-term Survival with Cardiac Resynchronization Therapy in Patients with Mild Heart Failure.

Ilan Goldenberg, MD, Valentina Kutyifa, MD, PhD, Helmut Klein, MD, Scott McNitt, MA, Mary Brown, MA, Arthur J. Moss, MD; and the MADIT-CRT LTFU Executive Committee. From the Cardiology Division of the Department of Medicine (I.G., VK, HK, SM, AJ.M) University of Rochester Medical Center, Rochester, N.Y.; and Leviev Heart Center, Sheba Medical Center and Tel Aviv University, Israel (I.G.)

. Objetivo: evaluar SV a largo plazo de DAI-CRT en población estudio MADIT-CRT: DAI-TRC vs DAI ,1820 pacientes, FEVI ≤ 30%, NYHA I/II, MD isquémica y no isquémica.

. Se analizaron 1651 pacientes sobrevivieron al estduio (Fase 1) y 859 pacientes incluidos en un registro que se inició tras la finalización del estudio.

. Cambios de dispositivo: DAI a DAI-TRC 9%; DAI-CRT a DAI: 5%

. Estudio junio 2004 a diciembre de 2009, seguimiento septiembre 2013.

. Análisis por intención de tratar y subgrupos con BRIHH y sin BRIHH

. Objetivo: evaluar SV a largo plazo de DAI-CRT en población estudio MADIT-CRT: DAI-TRC vs DAI ,1820 pacientes, FEVI ≤ 30%, NYHA I/II, MD isquémica y no isquémica.

. Se analizaron 1651 pacientes sobrevivieron al estduio (Fase 1) y 859 pacientes incluidos en un registro que se inició tras la finalización del estudio.

. Cambios de dispositivo: DAI a DAI-TRC 9%; DAI-CRT a DAI: 5%

. Estudio junio 2004 a diciembre de 2009, seguimiento septiembre 2013.

. Análisis por intención de tratar y subgrupos con BRIHH y sin BRIHH

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Mortalidad en BRIHH

NNT: 9HR ajustado: 0,59, IC 95%: 0,43,0,80, p < 0,001

18%

29%

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IC no fatal en BRIHH

HR ajustado: 0,38, IC 95%: 0,30 – 0,48, p < 0,001

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LBBB NLBBB P-INT

END POINT HR P-value HR P-value

All-cause mortality

0.59(0.43 – 0.80)

<0.001 1.57(1.03 – 2.39)

0.04 <0.001

Non-fatal HF 0.38(0.30 – 0.48)

<0.001 1.13(0.80 – 1.60)

0.48 <0.001

HF or death 0.45(0.37 – 0.56)

<0.001 1.27(0.94 – 1.73)

0.12 <0.001

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CORP-2 TrialEfficacy And Safety Of Colchicine In Patients With Multiple Recurrences Of Pericarditis

• Massimo Imazio, MD, FESC on behalf of the CORP-2 Investigators. Cardiology Dpt. Maria Vittoria Hospital, ASLTO2, Torino, Italy

. La colchicina ha demostrado en diversos ensayos clínicos que es eficaz y segura en el tratamiento y prevención de pericarditis aguda y en las primeras recidivas.

. Objetivo: evaluar eficacia y seguridad de colchicina en el tratamiento de pacientes con múltiples recidivas de pericarditis (≥ 2).

. Se incluyeron 240 pacientes en tratamiento máximo estandar con AINEs (aspirina, ibuprofeno o indometacina) a los que se randomizó (1:1) a colchicina (0,5 mg / 12h en > 70 Kg y ó 0,5 mg / 24h en < 70 kg) vs placebo, durante 6 meses.

. Seguimiento de al menos 18 meses.

. La colchicina ha demostrado en diversos ensayos clínicos que es eficaz y segura en el tratamiento y prevención de pericarditis aguda y en las primeras recidivas.

. Objetivo: evaluar eficacia y seguridad de colchicina en el tratamiento de pacientes con múltiples recidivas de pericarditis (≥ 2).

. Se incluyeron 240 pacientes en tratamiento máximo estandar con AINEs (aspirina, ibuprofeno o indometacina) a los que se randomizó (1:1) a colchicina (0,5 mg / 12h en > 70 Kg y ó 0,5 mg / 24h en < 70 kg) vs placebo, durante 6 meses.

. Seguimiento de al menos 18 meses.

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CORP-2 TrialEfficacy And Safety Of Colchicine In Patients With Multiple Recurrences Of Pericarditis

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The MSC-HF TrialAutotransplantation of Bone Marrow Derived Mesenchymal Stromal Cells in Patients with Severe Ischemic Heart Failure

• Anders Bruun Mathiasen, M.D. Rigshospitalet, Copenhagen University Hospital Copenhagen, Denmark

• Objetivo: evaluar si el tratamiento con células madre mesenquimales de médula ósea del propio paciente, mejora la función sistólica en IC isquémica grave.

• Criterios inclusión: 30-80 años, FEVI < 45%, NYHA II / III, no revascularizables y en tratamiento farmacológico máximo.

• Objetivo primario: cambios en el volumen telesistólico, medido mediante RM /CT.

• Objetivo: evaluar si el tratamiento con células madre mesenquimales de médula ósea del propio paciente, mejora la función sistólica en IC isquémica grave.

• Criterios inclusión: 30-80 años, FEVI < 45%, NYHA II / III, no revascularizables y en tratamiento farmacológico máximo.

• Objetivo primario: cambios en el volumen telesistólico, medido mediante RM /CT.

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The MSC-HF TrialAutotransplantation of Bone Marrow Derived Mesenchymal Stromal Cells in Patients with Severe Ischemic Heart Failure

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SYMPLICITY HTN 3 Trial Renal Denervation in Patients with Uncontrolled Hypertension

• Deepak L. Bhatt, M.D., M.P.H., David E. Kandzari, M.D., William W. O’Neill, M.D., Ralph D'Agostino, Ph.D., John M. Flack, M.D., M.P.H., Barry T. Katzen, M.D, et al. for the SYMPLICITY HTN-3 Investigators

• Evaluate both the safety and efficacy of percutaneous renal artery denervation in patients

with severe treatment-resistant hypertension.

• Prospective, single-blind, randomized, sham-controlled trial.

• Patients with severe resistant hypertension were randomly assigned in a 2:1 ratio to undergo

renal denervation or a sham procedure (Age ≥18 and ≤80 years at time of randomization. Stable medication

regimen including full tolerated doses of 3 or more antihypertensive medications of different classes, including a diuretic

(with no changes for a minimum of 2 weeks prior to screening) and no expected changes for at least 6 months. Office SBP

≥160 mm Hg based on an average of 3 blood pressure readings measured at both an initial and a confirmatory screening

visit, Written informed consent).

• The trial included 535 patients enrolled by 88 participating US centers.

• Evaluate both the safety and efficacy of percutaneous renal artery denervation in patients

with severe treatment-resistant hypertension.

• Prospective, single-blind, randomized, sham-controlled trial.

• Patients with severe resistant hypertension were randomly assigned in a 2:1 ratio to undergo

renal denervation or a sham procedure (Age ≥18 and ≤80 years at time of randomization. Stable medication

regimen including full tolerated doses of 3 or more antihypertensive medications of different classes, including a diuretic

(with no changes for a minimum of 2 weeks prior to screening) and no expected changes for at least 6 months. Office SBP

≥160 mm Hg based on an average of 3 blood pressure readings measured at both an initial and a confirmatory screening

visit, Written informed consent).

• The trial included 535 patients enrolled by 88 participating US centers.

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Primary Effectiveness Endpoint:• Comparison of office SBP change from baseline to 6 months in RDN arm compared

with change from baseline to 6 months in control arm

Endpoint = (SBPRDN 6 month – SBPRDN Baseline) – (SBPCTL 6 month – SBPCTL Baseline)

• Superiority margin of 5 mm Hg

Powered Secondary Effectiveness Endpoint:• Comparison of mean 24-hour ambulatory (ABPM) SBP change from baseline to 6

months in RDN arm compared with change from baseline to 6 months in control arm

• Superiority margin of 2 mm Hg

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Characteristicmean ± SD or %

Renal Denervation(N=364)

Sham Procedure(N=171 ) P

Age (years) 57.9 ± 10.4 56.2 ± 11.2 0.09Male sex (%) 59.1 64.3 0.26Office systolic blood pressure (mm Hg) 180±16 180±17 0.7724 hour mean systolic ABPM (mm Hg) 159±13 160±15 0.83BMI (kg/m2) 34.2 ± 6.5 33.9 ±6.4 0.56Race* (%) 0.57 African American 24.8 29.2 White 73.0 69.6 Medical history (%) Renal insufficiency (eGFR<60 ml/min/1.73m2) 9.3 9.9 0.88

Renal artery stenosis 1.4 2.3 0.48Obstructive sleep apnea 25.8 31.6 0.18Stroke 8.0 11.1 0.26Type 2 diabetes 47.0 40.9 0.19Hospitalization for hypertensive crisis 22.8 22.2 0.91

Hyperlipidemia 69.2 64.9 0.32

Current smoking 9.9 12.3 0.45

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Objetivo Primario de Eficacia:Cambio en Pas en consulta a 6 meses

Objetivo Secuncardio de Eficacia:Cambio en Pas en MAPA 24h a 6 meses

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The Global SYMPLICITY Registry:Safety and Effectiveness of Renal Artery Denervation In Real World Patients With Uncontrolled Hypertension

• Michael Böhm, MD on behalf of the GSR Investigators.Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany

• Prospective, open label, multi-center, international registry

• Up to 5000 real world patients with uncontrolled hypertension and some with conditions associated with sympathetic nervous system activation

• Key Inclusion: –Older than 18 years –Candidates for renal denervation as defined by local regulations for use of the

Symplicity™ catheter.

• Prospective, open label, multi-center, international registry

• Up to 5000 real world patients with uncontrolled hypertension and some with conditions associated with sympathetic nervous system activation

• Key Inclusion: –Older than 18 years –Candidates for renal denervation as defined by local regulations for use of the

Symplicity™ catheter.

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The Global SYMPLICITY Registry:Safety and Effectiveness of Renal Artery Denervation In Real World Patients With Uncontrolled Hypertension

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Investigadores españoles:Heart failure and Cardiomyopathies

• Cardiac magnetic resonance combined with cardiac 123I-MIBG. Imaging indentifies a very low risk patients for cardiac defibrillator implantation. Francisco Ridocci-Soriano, Pilar Garcia Gonzalez, Puig Cozar-Santiago, Oscar Fabregat Aandres, Bruno Bochard Villanueva, Rafael De La Espriella-Juan, Jordi Estornell-Erill, Alfonso Valle, Victor Palanca Gil, Jose Ferrer-Rebolleda, Aurelio Quesada-Dorador, Cardiology department-Consorcio Hospital General Universitario de Valencia, Valencia, Spain, ERESA-Consoncio Hospital General Universitario de Valencia, Valencia, Spain.

• Parathormone levels are independently associated with the presence of left ventricular hypertrophy in patients with coronary artery disease. Alvaro Aceña, Maria Gonzalez-Casaus, Luis Blanco-Colio, Jose Luis Martin Ventura, Ana Maria Pello, Rocío Carda, Julia Anna Palfy, Orejas Miguel, Rosa Rabago, Emilio Gonzalez-Parra, Oscar Lorenzo, Jeronimo Farre, Jesus Egido, José Tunon, IIS-Fundacion Jimenez Diaz, Madrid, Spain

• Value of clasical criteria for diagnosis of cardiaca amyloid in the cardiac magnetic resonance era. Eduardo Pozo, Jose Castellano, Rajiv Deochand, Anubhav Kanwar, Maria Eduarda Menezes de Siqueira, Jorge Rodriguez-Garrido, Teresa Arias, Matthew Cham, Jagat Narula, Valentin Fuster, Javier Sanz, Mount Sinai Medical Center, New York City, NY, USA, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.

• Percutaneous coronary intervention versus medical therapy for moderate coronary lesions after heart trasplantion: What to do?. Lilian Grigorian Shamajan, Zhe Yu, Frank Liou, Jignesh Patel, Michelle Kittleson, Babak Azarbal, David Chang, Lawrence Czer, Jon Kobashigawa, Cedars- Sinai Heart Institute, Los Angeles, CA, USA

lo mejor del acc 2014. insuficiencia cardiaca, hta y pericardio

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