Hemodynamic Effects of Sacubitril/Valsartan in Patients with Reduced Left Ventricular Ejection Fraction Over 24 Months: A Retrospective Study
Tóm tắt
The effects of sacubitril/valsartan in patients with chronic heart failure with reduced ejection fraction (HFrEF) were recently reported. However, the hemodynamic impact of this well-established treatment in patients with HFrEF has been poorly systematically researched. We aimed to investigate the hemodynamic effects of sacubitril/valsartan among patients with HFrEF. Between 2016 and 2020, we retrospectively collected data for patients with HFrEF treated at the University Medical Center Mannheim, Germany. Data for 240 patients with HFrEF were available. We systematically analyzed echocardiographic parameters, all-cause hospitalization, and congestion rate. The left ventricular ejection fraction (LVEF) improved from a median (minimum; maximum) of 28% (3; 65) before initiation of sacubitril/valsartan to a median of 34% (13; 64) at 24-month follow-up (p < 0.001). Systolic pulmonary atrial pressure (PAPsys) decreased from a median of 30 mmHg (13; 115) to 25 mmHg (20; 80) at 24-month follow-up (p = 0.005). The median (minimum; maximum) tricuspid annular plane systolic excursion improved from 17 mm (3; 31) at baseline to 20 mm (9; 30) at 12-month follow-up (p = 0.007). The incidence of severe and moderate mitral, tricuspid, and aortic valvular insufficiency improved after treatment. Hospitalization and congestion rates reduced at 24-month follow-up. The mortality rate in echocardiographic and functional nonresponders was higher than in responders (12.1 vs. 5.2%; p = 0.1 and 11.3 vs. 3.1%; p = 0.01, respectively). Follow-up 24 months after starting treatment with sacubitril/valsartan revealed sustained improvements in echocardiographic parameters, including LVEF, PAPsys, and cardiac valvular insufficiency. Rates of all-cause hospitalization and congestion had decreased significantly at follow-up. The mortality rate was higher in echocardiographic and functional nonresponders.
Tài liệu tham khảo
McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993–1004.
Januzzi JL Jr, Prescott MF, Butler J, et al. Association of change in n-terminal pro-b-type natriuretic peptide following initiation of sacubitril-valsartan treatment with cardiac structure and function in patients with heart failure with reduced ejection fraction. JAMA. 2019;332:1–11.
Almufleh A, Marbach J, Chih S, et al. Ejection fraction improvement and reverse remodeling achieved with sacubitril/valsartan in heart failure with reduced ejection fraction patients. Am J Cardiovasc Dis. 2017;7(6):108–13.
Solomon SD, Claggett B, Desai AS, et al. Influence of ejection fraction on outcomes and efficacy of sacubitril/valsartan (lcz696) in heart failure with reduced ejection fraction: The prospective comparison of arni with acei to determine impact on global mortality and morbidity in heart failure (paradigm-hf) trial. Circ Heart Fail. 2016;9(3):e002744.
Martens P, Belien H, Dupont M, Vandervoort P, Mullens W. The reverse remodeling response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction. Cardiovasc Ther. 2018;36(4):e12435.
Zern EK, Cheng S, Wolfson AM, et al. Angiotensin receptor-neprilysin inhibitor therapy reverses pulmonary hypertension in end-stage heart failure patients awaiting transplantation. Circ Heart Fail. 2020;13(2):e006696.
Sharifi Kia D, Benza E, Bachman TN, Tushak C, Kim K, Simon MA. Angiotensin receptor-neprilysin inhibition attenuates right ventricular remodeling in pulmonary hypertension. J Am Heart Assoc. 2020;9(13):e015708.
Romano G, Vitale G, Ajello L, et al. The effects of sacubitril/valsartan on clinical, biochemical and echocardiographic parameters in patients with heart failure with reduced ejection fraction: the “hemodynamic recovery.” J Clin Med. 2019;8(12):2165.
Nakai T, Ikeya Y, Kogawa R, et al. What are the expectations for cardiac resynchronization therapy? A validation of two response definitions. J Clin Med. 2021;10(3):514.
Daubert MA, Massaro J, Liao L, et al. High-risk percutaneous coronary intervention is associated with reverse left ventricular remodeling and improved outcomes in patients with coronary artery disease and reduced ejection fraction. Am Heart J. 2015;170(3):550–8.
Yenercag M, Arslan U, Dereli S, Coksevim M, Dogdus M, Kaya A. Effects of angiotensin receptor neprilysin inhibition on pulmonary arterial stiffness in heart failure with reduced ejection fraction. Int J Cardiovasc Imaging. 2021;37(1):165–73.
Kang DH, Park SJ, Shin SH, et al. Angiotensin receptor neprilysin inhibitor for functional mitral regurgitation. Circulation. 2019;139(11):1354–65.
Mullens W, Martens P. Sacubitril/valsartan to reduce secondary mitral regurgitation. Circulation. 2019;139(11):1366–70.
Ambrosy AP, Braunwald E, Morrow DA, et al. Angiotensin receptor-neprilysin inhibition based on history of heart failure and use of renin-angiotensin system antagonists. J Am Coll Cardiol. 2020;76(9):1034–48.
Ditewig JB, Blok H, Havers J, van Veenendaal H. Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: a systematic review. Patient Educ Couns. 2010;78(3):297–315.
Glader EL, Sjolander M, Eriksson M, Lundberg M. Persistent use of secondary preventive drugs declines rapidly during the first 2 years after stroke. Stroke. 2010;41(2):397–401.
Brown MT, Bussell JK. Medication adherence: who cares? Mayo Clin Proc. 2011;86(4):304–14.
Proudfoot C, Studer R, Rajput T, et al. Real-world effectiveness and safety of sacubitril/valsartan in heart failure: a systematic review. Int J Cardiol. 2021;331:164.