Background Most clinical data regarding the use of sacubitril-valsartan (SV) in patients with heart failure with reduce EF (HFrEF) come from clinical trials, while observational studies in real life are scarce. Purpose To analyse the efficacy, safety and tolerability of SV in patients with HFrEF in real life. Methods An analysis of the SAVE-RLife (SV Evidence in Real Life) study was performed. This is an observational and ambispective study that included all patients with HFrEF who started SV between SEP2016 and DEC2018. Results A total of 291 patients were included in the study with a median follow-up of 326 (169; 523). Mean age 66.16±11.8, 71 were women (24.4%), 209 patients started treatment at office (71.8%) and 82 during the admission (28.2%). The main aetiologies were ischemic heart disease (51.5%) and idiopathic dilated cardiomyopathy (35.4%). Comorbidities included: 71.5% hypertensive, 55.3% dyslipidemic, 37.1% AF and 44% T2DM. Baseline treatment included 85.9% beta-blockers, 87.2% ACEI or ARA-II, 65.6% MRA and 17.5% iSGLT2. After treatment start with SV, baseline and follow-up analytical parameters such as GFR, K+ levels and NT-BNP, and echo parameters of LV reverse remodeling were evaluated (Table 1). Improvement of the functional NYHA class (Figure 1) and reduction in the incidence of hospital admission or visits to emergency room (ER) were observed. Side effects were 16.2% acute renal failure, 9.3% symptomatic hypotension, 9.7% asymptomatic hypotension and 15.9% hyperkalemia. In 31 patients (11%) the drug was discontinued, one patient due to angioedema. 7.9% of patients died during follow-up, 7 of them due to HF (2.4%). Table 1 Before SV After SV P value Analytical data GFR (ml/min) 70.25±24.95 68.27±24.62 0.008 Serum K+(mEq/L) 4.53±0.50 4.71±0.456 <0.001 NT-proBNP (pg/ml) 2201 (846; 4664) 1146 (436; 2564) <0.001 Echocardiographic data LVEF (%) (n=84) 30.60±7.16 38.30±12.22 <0.001 LVED (mm) (n=72) 65.22±7.82 60.81±8.37 <0.001 PAPs (mmHg) (n=48) 44.48±13.03 37.52±12.25 0.002 MR (grade 1–4) (n=71) 1.83±0.91 1.38±0.90 <0.001 Clinical outcomes HF Hospital/ER Admission the year before (mean± SD) 0.79±1.09 0.41±0.963 <0.001 Predictors of clinical improvement Conclusions SV has shown to improve morbidity and mortality in patients with HFrEF by improving functional class, decreasing NT-proBNP levels and reducing admissions due to HF, without significant side effects. In our study SV improved LVEF and reverse remodeling echocardiographic parameters too.

Las manifestaciones cutáneo-mucosas de la lúes secundaria suelen ocultar la expresión sistémica de dicha enfermedad, aunque pueden estar ausentes hasta en el 25% de los casos. Las manifestaciones sistémicas como fiebre, artralgias, meningitis, hepatitis, osteítis y síndrome nefrótico son menos frecuentes (1,2), si bien existe un número considerable de casos publicados con síndromes aislados de esta semiología sistémica, que determina aproximadamente unas 80 citas bibliográficas en una búsqueda Medline (1960-2006). La semiología sistémica florida asociada a anticoagulante circulante es rara, como lo muestra una búsqueda en Medline, que representa sólo 3 casos, y un cuarto coexistiendo con fiebre Q (3-6). Coexistiendo con lesiones focales hepáticas (LOES) solamente existen 2 citas bibliográficas (7,8). Recientemente hemos estudiado un paciente con clínica sistémica, consisten-te en fiebre, diátesis hemorrágica, artralgias, reacción meníngea, síndrome nefrótico y hepatitis colestática, en la que destaca junto a esa marcada semiología la presencia de LOES hepáticas y anticoagulante circulante, con rápida desaparición de todo el cuadro clínico tras tratamiento con penicilina, lo que es el motivo de esta presentación. Estas manifestaciones asociadas son descritas en la literatura de modo aislado (3-14), no existiendo hasta el momento actual en Medline ningún caso con toda la semiología comentada. CASO APORTADO Varón de 37 años, que encontrándose relativamente estacionario hacia finales de marzo del 2006 comenzó a notar náuseas, vómitos y dificultad para tragar de comienzo brusco, y una semana después quebrantamiento del estado general, mialgias en cintura escapular y [0212-7199 (2007) 24: 7; pp 331-334] ANALES DE MEDICINA INTERNA