Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report

• Autor(a) principal: Caldas, Marcia Azevedo
• Data de Publicação: 2022
• Outros Autores: Perez, Gabriel Barreto, Alexandre, Liliane Ferreira, Figueiredo, Marya Alice Sardinha
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista Científica da Faculdade de Medicina de Campos
• Texto Completo: https://www.fmc.br/ojs/index.php/RCFMC/article/view/586
• topic: Dapagliflozina; Doença rena crônica; Insuficiência cardíaca; Chronic Kidney Disease; Dapagliflozin; Heart Failure

Heart failure (HF) is the common end of several heart diseases, with great socioeconomic impact in Brazil andworldwide. To report the clinical improvement of the associationof dapaglifozin to the traditional therapeutic regimen of a patient with HF with reduced ejection fraction(HFpEFr) with difficult clinical control during hospitalization. A 63 year old woman, hypertensive, diabetic, with chronic kidney disease, coronary artery disease and peripheral disease, admitted with functional class IV HF(NYHA) - dyspnea on minimal effort, orthopnea, paroxysmal nocturnal dyspnea and edema of the lower limbs. On admission she presented with BP 130x80mmHg, RCR 3t (B3), HR 89bpm, mitral systolic murmur +2/6, pulmonary bibasilar crackles. Echocardiographic findings showed significant LV systolic dysfunction due to diffuse hypokinesia with EF of 18%. During hospitalization, despite therapeutic optimization, the patient didn't present functional classimprovement, with the need at times to reduce the dose of diuretics and vasodilators due to deterioration of renal function. Dapagliflozin 10 mg was associated to the therapeutic scheme and a daily adjustment of the othermedications was made. The following days were marked by clinical improvement of symptoms, and the patient was discharged on the 23rd day of hospitalization in functional class II. The clinical control of ICFEr, despite allthe available therapeutic arsenal, is still a challenge for many experienced specialists. The clinical evolution ofthe patient in question is in line with the main findings described in the DAPAHF and DAPA-CKD studies, whichdemonstrated a lower risk of worsening of HF or death from cardiovascular causes and reduced risk of worsening of renal function and death from renal or cardiovascular causes, respectively. By using dapagliflozin, the patient showed clinical improvement after failed attempts at conventional drug treatments.