Effect of sacubutril/valsartan on Tp-e, QT, QTc, Tp-e/QTc parameters in heart failure with reduced ejection fraction

Abstract

Purpose: The purpose of this study is to evaluate ventricular repolarization before, at the first month, and sixth month after Sacubutril/Valsartan, an angiotensin receptor neprilysin inhibitor (ARNI) treatment in heart failure patients with reduced ejection fraction (HFrEF).
 Materials and Methods: We included 49 patients with HFrEF who switched to ARNI therapy. The 12-lead electrocardiography (ECG) was evaluated before ARNI therapy and also during the first and sixth months of the therapy. We evaluated demographic, clinical, and laboratory parameters, as well as medications and ECG data, including heart rate. Additionally, we examined QT, QTc, Tp-e, Tp-e calculated (Tp-ec), Tp-ec/QTc, Tp-e/QT, and Tp-e/QTc.
 Results: After receiving ARNI treatment, ventricular repolarization indices were significantly reduced in the first and sixth months compared to before treatment. Specifically, the QTc values decreased from 457.6 ms to 443.8 ms, and the Tp-e/QT ratio decreased from 0.21±0.03 to 0.19±0.03. Additionally, the QTc values decreased from 457.6 ms to 444.9 ms, and the Tp-e/QT ratio decreased from 0.21±0.03 to 0.18±0.03. However, when the first and sixth months under ARNI treatment were compared, no significant difference was found (QTc: 443.8 ms vs. 444.9 ms, Tp-e/QT: 0.19±0.03 vs. 0.18±0.003).
 Conclusion: ARNI treatment in HFrEF positively affected QTc, Tp-e, and Tp-ec intervals and Tp-e/QT, Tp-e/QTc, and Tp-ec/QTc ratios, which are indicators of ventricular repolarization. Moreover, this effect started in the first month and continued in the sixth month.