Optimal management of young patients with dilated cardiomiopathy undergoing Sacubitril / Valsartan treatment

Introduction: Dilated cardiomyopathy is a complex pathology with multiple therapeutic and prognostic implications, whereas the etiology remains unidenti-fied in about 50% of patients. Its optimal management implies an extensive clinical and biological assessment that can lead to myocardial biopsy or even genetic tes-ting in familial forms or those suspected of having a rare genetic disorder.

Methods: A 49-year-old male with no significant pathological history, without any toxic behaviors, asymptomatic until 3 months ago, was admitted to the pneumology department for unusual thoracic pain and nocturnal dyspnea. Following the clinical and paracli-nical assessment the suspicion of dilated cardiomyo-pathy was raised. The cardiological evaluation confir-med the diagnosis and showed severe left ventricular systolic dysfunction with a 10% ejection fraction. Beca-use of the clinical picture of global cardiac decompen-sation, drug therapy with beta-blocker, spironolactone, furosemide, angiotensin conversion enzyme inhibitor and aspirin were recommended. The persistent symp-tomatology determined the patient to address our de-partment for reassessment.

Results: Clinical and biological there were signs of glo-bal heart failure, hypotension, dyselectrolytemia, he-patic cytolysis syndrome. On the ECG ventricular ar-rhythmias were observed. Echocardiographic reevalu-ation showed a persistent severe left ventricular systo-lic dysfunction. Treatment with Sacubitril / Valsartan 49/51 mg x 2 / day was initiated, which was then redu-ced to 24/26 mg x 2 / day due to orthostatic hypoten-sion. Cardiac computer tomography revealed normal coronary arteries. Upon discharge, it was recommen-ded to associate anticoagulant, beta-blocker, diuretics and ivabradine. Revaluation at one month showed an improvement in echocardiographic parameters (25% ejection fraction). Three months after discharge, the disappearance of cardiac failure symptomatology and a 40% ejection fraction were noted.

Conclusions: Dilated cardiomyopathy is accompanied by an extremely variable prognosis, etiology being one of the defining factors due to the possibility of applying a specific treatment (anti-inflammatory, immunomodulatory, antiviral). The particularity of this case is re-presented by the patient’s profile, without pre-existing cardiac disease, in which investigations were not able to detect the etiology. The association of Sacubitril / Val-sartan and ivabradine to the maximum possible dosage lead to clinical improvement of echocardiographic pa-rameters (increase of the left ventricle ejection fraction from 10% to 40%) and implicitly of the prognosis by decreasing the hospitalization rate.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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