Clinical and hemodynamic improvement in pulmonary hypertension after switching to sacubitril/valsartan in heart failure patients with preserved ejection fraction

Abstract

Patients with heart failure with preserved ejection fraction (HFpEF) and pulmonary hypertension have poor survival, and established medical therapies for both conditions are not available. In this retrospective study of 69 patients with HFpEF and either isolated postcapillary pulmonary hypertension (IpcPH, n = 53) or combined postcapillary and precapillary pulmonary hypertension (CpcPH, n = 16), we investigated the effects of sacubitril/valsartan on pulmonary hypertension measured using right heart catheterization (RHC) at baseline (i.e., pre-sacubitril/valsartan) and 99 (94 - 123) days after switching to sacubitril/valsartan. After switching to sacubitril/valsartan, RHC showed significantly lower pulmonary artery pressures (systolic/diastolic/mean) in both patient groups compared to pre-sacubitril/valsartan (IpcPH:44 [38 - 52]/15 [12 - 19]/28 [22 - 33] mm Hg versus 47 [40 - 55]/18 [15 - 23]/31 [26 - 35] mm Hg, p < 0. 01; CpcPH: 54 [43 - 57]/18 [12 - 23]/34 [30 - 36] mm Hg versus 61 [50 - 79]/24 [19 - 30]/40 [31 - 53] mm Hg, p < 0.05). The median sacubitril/valsartan dose at follow-up was 24/26 (24/26 - 49/51) mg BID in both IpcPH and CpcPH patients. Clinically, the New York Heart Association functional class improved by at least one class in 32 of 69 patients (p < 0.01). In conclusion, sacubitril/valsartan therapy improves pulmonary hypertension in patients with HFpEF and either IpcPH or CpcPH. Further prospective randomized trials are needed for confirmation of our results.