Effect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Patients With Heart Failure and Reduced Ejection Fraction

Abstract

IMPORTANCE Compared with enalapril, sacubitril-valsartan reduces cardiovascular mortality and heart failure hospitalization in patients with heart failure and reduced ejection fraction (HFrEF). These benefits may be related to effects on hemodynamics and cardiac remodeling. OBJECTIVE To determine whether treatment of HFrEF with sacubitril-valsartan improves central aortic stiffness and cardiac remodeling compared with enalapril. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind clinical trial of 464 participants with heart failure and ejection fraction of 40% or less enrolled across 85 US sites

The Effect of Sacubitril/Valsartan on Device Detected Arrhythmias and Electrical Parameters among Dilated Cardiomyopathy Patients with Reduced Ejection Fraction and Implantable Cardioverter Defibrillator

“…These data, in contrast with the results of the Paradigm HF Trial [1] and other real-world experiences [6][7][8], may be explained by the electro-mechanical atrial reverse remodeling [13], since significant reduction in atrial volumes, as well an improvement in electrocardiographic indexes of heterogeneity in atrial conduction, were observed in our study population after sacubitril/valsartan treatment. Our findings expand the recently described positive effect of sacubitril/valsartan treatment on atrial volumes [14,15] and among atrial electrical parameters, suggesting the hypothesis of a complete electro-mechanical atrial reverse remodeling.…”

“…Moreover, we showed a statistically significant reduction in the number of patients who experienced VT/VF episodes, both sustained and non-sustained, and appropriate ICD shock events on sacubitril/valsartan treatment at 12 months follow-up. These results may be a consequence of the mechanical and functional reverse ventricular remodeling, since we documented the reduction in ventricular volumes and the improvement in left ventricular function, both systolic and diastolic, confirming the evidences from previous studies [2,15]. However, in contrast with Gonçalves et al [9], we showed a trend in improvement in electrocardiographic indexes of dispersion of ventricular repolarization, which did not reach the statistical significance.…”

LCZ696 and preservation of renal function in heart failure: A meta-analysis of 6 randomized trials

“…A total of 6 clinical RCT trials comparing LCZ696 vs. ACEI/ARB included in the meta-analysis (Desai et al, 2019;Kang et al, 2019;McMurray et al, 2014;Solomon et al, 2012Solomon et al, , 2019Velazquez et al, 2019). The detailed characteristics of these 6 studies are listed in Table 1.…”

Reappraisal on pharmacological and mechanical treatments of heart failure

“…These findings of sacubitril/valsartan with stunning interest laid the foundation forrecommendations in guidelines [2,7,16]. PIONEER-HF further confirmed the necessity of early use of sacubitril/valsartan in HFrEF [24], and the reduction in N-terminal pro-B-type natriuretic peptide (NT-pro BNP) concentration was weakly yet significantly correlated with reverse cardiac remodelling at 12 months [25]; however, sacubitril/valsartan showed no better reduction in central aortic stiffness than enalapril in HFrEF [26]. An analysis of the TRANSITION study indicated that sacubitril/valsartan has promising results in patients who are naïve to angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) treatment [27] as well as in patients with de novo HFrEF [28].…”

“…Pharmacotherapy Tolvaptan TACTICS-HF [8], AQUAMARINE [9,10], Shirakabe et al [11], EVEREST [12], SECRET, QUEST, METEOR [13] Ivabradine SHIFT [14,15], INTENSIFY, ETHIC-AHF, Bagriy et al [17], CARVIVA HF [18] Sacubitril/valsartan PARADIGM-HF [19][20][21][22][23], PIONEER-HF [24,25], EVALUATE-HF [26], TRANSITION [27,28], PARAMOUNT [29,30], PARAGON-HF [31] Nebivolol SENIORS [33][34][35][36][37], Sessa et al [38], Brehm et al [39], ELANDD [40], CARNEBI [41] Levosimendan LIDO [42], SURVIVE [43], REVIVE [44], LevoRep [45], Zhang et al [46], LION-HEART [47], LEAF [48], Jia et al [49], LAICA [50], Leo-DOR [51] MRA Eplerenone: EPHESUS [75], EMPHASIS-HF [52][53][54][55]…”