Effects of sacubitril/valsartan on ventricular remodeling in patents with left ventricular systolic dysfunction following acute anterior wall myocardial infarction

Abstract

Objective The aim of this study was to investigate the effect of sacubitril/valsartan (Sal/Val) on left ventricular (LV) remodeling in patients with LV systolic dysfunction following acute anterior wall myocardial infarction (AAMI). Methods AAMI patients with LV systolic dysfunction were enrolled in this study. All patients underwent percutaneous coronary intervention. After hemodynamic stabilization, patients were randomly assigned either to group T (Sal/Val treatment) or group C (enalapril treatment). Changes in echocardiographic parameters and plasma biochemical markers were used to evaluate the effects of Sal/Val on LV remodeling and cardiac function. The incidence of major cardiac adverse events (MACEs) and adverse reactions during follow-ups was also recorded. Results In total, 137 eligible patients were prospectively included. Compared to group C, LV ejection fraction significantly improved (P < 0.05), while the LV end-systolic volume index and wall motion score index showed a tendency to decrease in group T. There was no difference in the LV end-diastolic volume index between groups. During follow-ups, the plasma N-terminal pro-B-type natriuretic peptide and soluble suppression of tumorigenesis-2 levels in both groups decreased (all P < 0.05), and the change was more prominent in group T. Additionally, drug-related adverse effects were similar between the two groups (P > 0.05); however, the incidence of MACEs was lower in group T than in group C (39.71% vs. 53.62%, P = 0.103), although the difference was insignificant. Conclusion Sac/Val attenuated LV remodeling and dysfunction and was safe and effective in LV systolic dysfunction patients post AAMI.

Efficacy and safety of early initiation of Sacubitril/Valsartan in patients after acute myocardial infarction: A meta‐analysis

“…Rezq's study 14 showed that the incidence of MI in the Sacubitril/Valsartan group was lower than that in the ACEI group (1% vs. 2%). On the contrary, Wang's study 15 showed the incidence of MI the Sacubitril/Valsartan group was higher than that in the ACEI group (5.9% vs. 4.3%).…”

“…Kunbhani 17 declared that the patients were randomized via an interactive response technology. Only Wang 15 noted that the patients were assigned by the envelope method.…”

“…Two trials 14,15 involving 337 patients reported myocardial infarction outcome. However, a meta-analysis could not be performed due to the limited number of trials.…”

“…Three studies [14][15][16] involving 493 patients reported the MACE outcome. The significant heterogeneity was not noted between the included studies (I 2 = 0.0%, P = .414).…”

Duálna inhibícia neprilyzínu a receptora typu 1 pre angiotenzín II vo svetle klinických štúdií / Dual inhibition of neprilysin and angiotensin II type 1 receptor in light of clinical studies

“…Vzhľadom na skutočnosť, že experimentálne údaje naznačujú antifibrotický a antiremodelačný potenciál ARNi, možno predpokladať jeho benefit u pacientov po prekonaní infarktu myokardu. V štúdii na 137 pacientoch so systolickou dysfunkciou ĽK po akútnom infarkte prednej steny myokardu a perkutánnej koronárnej intervencii, sakubitril/ valsartan zmiernil remodeláciu a dysfunkciu ĽK a znížil výskyt závažných kardiovaskulárnych udalostí v porovnaní s enalaprilom (48). Na 186 pacientoch s infarktom myokardu s eleváciou ST-segmentu, včasné podanie sakubitril/valsartanu (vs. konvenčné ACEi) do 24 hodín po perkutánnej koronárnej intervencii redukovalo veľkosť infarktu meraného šesť mesiacov po príhode pomocou emisnej počítačovej tomografie (SPECT) (49).…”