Effect of SAcubitril/Valsartan on left vEntricular ejection fraction and on the potential indication for Implantable Cardioverter Defibrillator in primary prevention: the SAVE-ICD study

Guerra, Federico; Ammendola, Ernesto; Ziacchi, Matteo; Aspromonte, Vittorio; Pellegrino, Pier Luigi; Giorno, Giuseppe Del; Dell’Era, Gabriele; Pimpini, Lorenzo; Santoro, Francesco; Floris, Roberto; Stronati, Giulia; Nigro, Gerardo; Paolisso, Pasquale; Guido, Alessandro; Maglia, Giampiero; Brunetti, Natale Daniele; Carbone, A.; Gravellone, Miriam; Antonicelli, Roberto; Cannone, Michele; Accogli, Michele; Russo, Antonio Dello; Palmisano, Pietro

doi:10.1007/s00228-021-03189-8

Cited by 20 publications

(16 citation statements)

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“… 15 A favourable LV reverse remodelling seems to be the main responsible mechanism, 18 as Martens et al 19 suggested after studying 151 patients with HFrEF, in whom they observed a lower degree of ventricular tachycardia or fibrillation, resulting in less ICD intervention rate, over a mean follow-up of 365 days. Also, Guerra et al 20 conducted a prospective study in a similar cohort treated with sacubitril/valsartan for 6 months, showing LV reverse remodelling and an improvement of LVEF from 28.3 ± 5.6% to 32.2 ± 6.5% ( P < 0.001), with 5.3% arrhythmias in the first 6 months of treatment with sacubitril/valsartan.…”

Section: Discussionmentioning

confidence: 94%

Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register

Pastore

Mandoli

Giannoni

et al. 2021

European Heart Journal Open

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Background This sub-study deriving from a multicenter Italian register (DISCOVER-ARNI) investigated whether sacubitril/valsartan in adjunction of optimal medical therapy(OMT) could reduce the rate of implantable cardioverter-defibrillator(ICD) indications for primary prevention in heart failure with reduced ejection fraction(HFrEF) according to European guidelines indications, and its potential predictors. Methods In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centers were included. Lack of follow-up or speckle tracking data represented exclusion criteria. Demographic, clinical, biochemical and echocardiographic data were collected at baseline and after 6 months from sacubitril/valsartan initiation. Results Of 351 patients, 225(64%) were ICD carriers and 126(36%) were not ICD carriers (of whom 13 had not indication) at baseline. After 6 months of sacubitril/valsartan, among 113 non-ICD carriers despite having baseline left ventricular (LV)EF≤35% and New York Heart Asscociation(NYHA) class=II-III, 69(60%) did not show ICD indications; 44(40%) still fulfilled ICD criteria. Age, atrial fibrillation, mitral regurgitation>moderate, left atrial volume index(LAVi), and LV global longitudinal strain(GLS) significantly varied between the groups. With ROC curves, age≥75 years, LAVi≥42ml/m2 and LV GLS≥-8.3% were associated with ICD indications persistence (AUC=0.65,=0.68,=0.68 respectively). With univariate and multivariate analysis, only LV GLS emerged as significant predictor of ICD indications at follow-up in different predictive models. Conclusions Sacubitril/valsartan may provide early improvement of NYHA class and LVEF, reducing the possible number of implanted ICD for primary prevention in HFrEF. Baseline reduced LV GLS was a strong marker of ICD indication despite OMT. Early therapy with sacubitril/valsartan may save infective/hemorrhagic risks and unnecessary costs deriving from ICDs.

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Section: Discussionmentioning

confidence: 94%

Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register

Pastore

Mandoli

Giannoni

et al. 2021

European Heart Journal Open

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“…Such discrepancy from our results may be ascribed to the short followup (3 months) and the low dose of S/V achieved by patients enrolled in the study by Almufleh et al [29]. Due to the significant improvement in LVEF in non-IHD patients (9.5% median increase in 3D LVEF), it could be speculated that device (ICD or CRT) implantation for primary prevention and/or heart transplantation or LV assist device (LVAD) implantation could be prevented or at least delayed in these patients after the introduction of S/V therapy at the maximum tolerated dose, as recently suggested [30].…”

Section: Discussionmentioning

confidence: 95%

Cardiac Reverse Remodelling by 2D and 3D Echocardiography in Heart Failure Patients Treated with Sacubitril/Valsartan

et al. 2021

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In terms of sacubitril/valsartan (S/V)-induced changes in heart failure with reduced ejection fraction (HFrEF) via three-dimensional (3D) transthoracic echocardiography (TTE) and S/V effects based on HF aetiology, data are lacking. We prospectively enrolled 51 HFrEF patients (24 ischaemic, 27 non-ischaemic). At baseline and at 6-month follow-up (6MFU) after S/V treatment optimisation, we assessed the N-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac remodelling by two-dimensional (2D) and 3DTTE. In non-ischaemic patients, 2D and 3DTTE showed an improvement in left ventricular (LV) size and biventricular function at 6MFU vs. baseline: 3D-LV end-diastolic volume (EDV) 103 ± 30 vs. 125 ± 32 mL/m2 (p < 0.05), 3D-LV ejection fraction (EF) 40 ± 9 vs. 32 ± 5% (p < 0.05), right ventricular (RV) 3D-EF 48.4 ± 6.5 vs. 44.3 ± 7.5% (p < 0.05); only the 3D method detected RV size reduction: 3D-RVEDV 63 ± 27 vs. 71 ± 30 mL/m2 (p < 0.05). In ischaemic patients, only 3DTTE showed biventricular size and LV function improvement: 3D-LVEDV 112 ± 29 vs. 121 ± 27 mL/m2 (p < 0.05), 3D-LVEF 35 ± 6 vs. 32 ± 5% (p < 0.05), 3D-RVEDV 57 ± 11 vs. 63 ± 14 mL/m2 (p < 0.05); RV function did not ameliorate. In both ischaemic and non-ischaemic patients, diastolic function and NT-proBNP significantly improved. In HFrEF patients treated with S/V, 3DTTE helps to ascertain subtle changes in heart chambers’ size and function, which have a major impact on HFrEF prognosis. S/V has significantly different effects on LV function in non-ischaemic vs. ischaemic patients.

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“…We previously published from PROVE-HF that up to 62% of study participants meeting criteria for ICD implantation were no longer eligible after 12 months of treatment with Sac/Val (22). Similarly, in the SAVE-ICD study (23), Guerra and colleague found that Sac/Val improved LVEF after 6 months of treatment and prevented ICD implantation in 1 out of 4 patients with HFrEF. These data should be interpreted as hypothesis-generating but clearly support the need to optimize GDMT with Sac/Val prior to consideration of decision-making regarding ICD.…”

Section: Discussionmentioning

confidence: 94%

Heart Failure Duration and Mechanistic Efficacy of Sacubitril/Valsartan in Heart Failure With Reduced Ejection Fraction

Mohebi¹,

Liu²,

Felker³

et al. 2022

Journal of Cardiac Failure

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Effect of SAcubitril/Valsartan on left vEntricular ejection fraction and on the potential indication for Implantable Cardioverter Defibrillator in primary prevention: the SAVE-ICD study

Cited by 20 publications

References 25 publications

Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register

Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register

Cardiac Reverse Remodelling by 2D and 3D Echocardiography in Heart Failure Patients Treated with Sacubitril/Valsartan

Heart Failure Duration and Mechanistic Efficacy of Sacubitril/Valsartan in Heart Failure With Reduced Ejection Fraction

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