| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 824.22 KB | Adobe PDF |
Authors
Abstract(s)
A insuficiência cardíaca (IC) é definida pela American Heart Association como
“um síndrome clínico complexo que resulta de uma alteração funcional e/ou estrutural do
enchimento ou ejeção ventricular”.
É uma das doenças com maior impacto a nível da saúde pública global, com uma
prevalência de cerca de 26 milhões em todo o mundo (1-2% da população) e continua a ser
a principal causa de morbimortalidade cardiovascular. Mais de 50% dos doentes morrem
cinco anos após o diagnóstico, o que representa uma taxa de sobrevivência inferior à de
muitos cancros.
A prevalência da IC aumenta com a idade, atingindo 6-10% dos indivíduos com
idade superior a 65 anos. Na Europa a mortalidade intra-hospitalar por IC ronda os 7-9%,
sendo atualmente superior à do enfarte agudo do miocárdio. Adicionalmente, as mais
recentes projeções indicam que a prevalência de IC aumentará em 25% até 2030.
O triplo bloqueio neuro-hormonal alcançado quando se utiliza a combinação de um
inibidor da enzima conversora da Angiotensina + ß-Bloqueantes + antagonistas dos
mineralocorticóides, demonstrou uma maior redução na mortalidade e nos internamentos
por IC. É por isso, considerado atualmente o pilar do tratamento da IC com fração de
ejeção reduzida (IC FEr). No entanto, apesar destes avanços, a mortalidade aos 3 anos
destes pacientes continua acima dos 30%.
Novos medicamentos têm sido desenvolvidos e recentemente aprovados no
tratamento desta patologia. Fármacos como o Sacubitril/Valsartan, o Levosimendan e os
inibidores da SGLT-2 prometem expandir o número de opções terapêuticas na IC FEr e
até tratar a IC e as suas comorbilidades (ex. diabetes) em simultâneo.
Contudo, uma grande percentagem das mortes entre pacientes com IC, ocorre de
forma súbita e inesperada. Muitos destes casos são devido a alterações elétricas e, por isso,
investir em terapêuticas que melhorem ou atrasem a progressão das doenças
cardiovasculares, terá um impacto significativo na redução dos casos de morte súbita. É
neste paradigma que os dispositivos intracardíacos entram em ação.
A terapia de ressincronização cardíaca e os cardio-disfibrilhadores implantáveis
têm sido utilizados no tratamento da IC há vários anos. No entanto, sabemos que as
indicações para a sua utilização são restritas e nem todos os pacientes respondem favoravelmente à sua implantação. Novos desenvolvimentos tecnológicos a nível dos left
ventricular assist devices e o surgimento de novos dispositivos de modulação da
contratilidade cardíaca, podem permitir combater esta problemática e alcançar um
número substancialmente maior de doentes, quando a terapia farmacológica otimizada
falha.
Heart failure (HF) is defined by the American Heart Association as "a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood.” It´s a disease that has a major impact on global public health, with a prevalence of around 26 million worldwide (1-2% of the population) and remains as the main cause of cardiovascular morbidity and mortality. More than 50% of patients die, five years after the diagnosis is made, which represents a survival rate lower than most cancers. The prevalence of HF increases with age, reaching 6-10% in patients over the age of 65. In Europe, hospital mortality from HF is around 7-9%, being currently higher than that of acute myocardial infarction. In addition, the most recent projections indicate that the prevalence of HF will increase by 25% by 2030. The triple neurohormonal blockade achieved by using an angiotensin-converting enzyme inhibitor + beta-blocker + mineralocorticoid receptor antagonist, has been shown to lead to a greater reduction in mortality and hospitalizations related to HF. That is why it is currently considered the main pillar in the treatment of HF with reduced ejection fraction (HFrEF). However, despite these advances, the mortality at the 3 years mark in these patients remains above 30%. New drugs have been developed and approved in the treatment of this condition. Agents such as Sacubitril / Valsantan, Levosimendan and SGLT-2 inhibitors promise to expand the number of therapeutic options against HFrEF and even allow the possibility to treat HF and its comorbidities (e.g. Diabetes) at the same time. However, a large percentage of deaths among patients with HF occur suddenly and unexpectedly. Many cases are due to electrical changes and, therefore, investing in therapies that improve or delay the progression of CV diseases will have a significant impact in reducing cases of sudden death. It is in this paradigm that cardiac devices come into play. Cardiac resynchronization therapy and implantable cardioverter defibrillator have been used in the treatment of HF for several years. However, we know that the indications for its use are restricted and not all patients are likely to have a positive response. New technological developments in the left ventricular assist device department and the emergence of new cardiac contractility modulation devices (CCM), may allow to tackle this problem and reach a greater number of patients, when optimal medical treatment fails.
Heart failure (HF) is defined by the American Heart Association as "a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood.” It´s a disease that has a major impact on global public health, with a prevalence of around 26 million worldwide (1-2% of the population) and remains as the main cause of cardiovascular morbidity and mortality. More than 50% of patients die, five years after the diagnosis is made, which represents a survival rate lower than most cancers. The prevalence of HF increases with age, reaching 6-10% in patients over the age of 65. In Europe, hospital mortality from HF is around 7-9%, being currently higher than that of acute myocardial infarction. In addition, the most recent projections indicate that the prevalence of HF will increase by 25% by 2030. The triple neurohormonal blockade achieved by using an angiotensin-converting enzyme inhibitor + beta-blocker + mineralocorticoid receptor antagonist, has been shown to lead to a greater reduction in mortality and hospitalizations related to HF. That is why it is currently considered the main pillar in the treatment of HF with reduced ejection fraction (HFrEF). However, despite these advances, the mortality at the 3 years mark in these patients remains above 30%. New drugs have been developed and approved in the treatment of this condition. Agents such as Sacubitril / Valsantan, Levosimendan and SGLT-2 inhibitors promise to expand the number of therapeutic options against HFrEF and even allow the possibility to treat HF and its comorbidities (e.g. Diabetes) at the same time. However, a large percentage of deaths among patients with HF occur suddenly and unexpectedly. Many cases are due to electrical changes and, therefore, investing in therapies that improve or delay the progression of CV diseases will have a significant impact in reducing cases of sudden death. It is in this paradigm that cardiac devices come into play. Cardiac resynchronization therapy and implantable cardioverter defibrillator have been used in the treatment of HF for several years. However, we know that the indications for its use are restricted and not all patients are likely to have a positive response. New technological developments in the left ventricular assist device department and the emergence of new cardiac contractility modulation devices (CCM), may allow to tackle this problem and reach a greater number of patients, when optimal medical treatment fails.
Description
Keywords
Dispositivos Intracardíacos Insuficiência Cardíaca Terapêutica Farmacológica