Favorable Effects of Sacubitril/Valsartan on the Peak Atrial Longitudinal Strain in Patients With Chronic Heart Failure and a History of One or More Episodes of Atrial Fibrillation: A Retrospective Cohort Study

Abstract

Background: The peak atrial longitudinal strain (PALS) is primarily an index of the reservoir function of atrial chambers. The conceptual basis exists to hypothesize that sacubitril/valsartan improves the expandability of atrial chambers in the reservoir phase of the atrial mechanical cycle, as a consequence of its effect of prolonging the half-life of natriuretic peptides. Therefore in this retrospective study we evaluated the repercussions of the administration of sacubitril/valsartan maintained for at least 12 months on the PALS. Methods: In our retrospective study a cohort of 40 patients treated with sacubitril/valsartan has been compared with a second cohort subjected to the conventional treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker. A general criterion to be satisfied was the presence of at least one episode of atrial fibrillation (AF) in the history of the enrolled patients. The study population was composed of New York Heart Association (NYHA) class II/III chronic heart failure (CHF) patients, due to the fact that the treating physicians of the patients whose clinical records were used as source of data, complied with the international guidelines that have so far validated sacubitril/valsartan exclusively for the CHF therapy. The aims were to verify whether the 1-year administration of sacubitril/valsartan is effective in improving the PALS, and also ascertain whether the drug is associated with a decreased risk of AF relapses over a mean retrospective observation period of 12 months. Results: Sacubitril/valsartan cohort was proven to benefit from a significant increase in average values of PALS (median: 26.5%; in-terquartile range (IQR): 22%-30%), opposed to the much less pronounced increase in PALS found in the conventional therapy cohort (median: 22.5%; IQR: 18%-25.5%). Additionally, the comparison made by means of one-way analysis of variance regarding the mean changes of PALS values, outlined clearly that the sacubitril/valsartan users had an increase in PALS after 1 year of therapy significantly greater (P < 0.001) compared to the patients taking the conventional drugs. Moreover, a risk significantly higher of AF recurrences (P = 0.001) was identified in the conventional therapy group compared to the sacubitril/valsartan group during a 12-month retrospective observation period. Conclusions: In the present retrospective cohort study a higher increase of PALS has been shown in the cohort treated with sacubitril/valsartan. Moreover, a reduced risk of AF recurrences has been shown in the sacubitril/valsartan users compared to the patients with CHF subjected to conventional treatment.

Upstream Therapy for Atrial Fibrillation Prevention: The Role of Sacubitril/Valsartan

“…Sacubitril/valsartan does not have an intrinsic antiarrhythmic effect; however the increase in the half-life of ANP and BNP that it induces allows these cardioprotective hormones to more intensely regulate the function of the atria and ventricles. This occurs at the level of the atria through a preservation of the reservoir function, that is, the aspiration of caval and pulmonary venous blood into the right and left atrium, respectively, during the ventricular systole [34]. More-over, at the ventricular level, the drug acts by increasing the global longitudinal strain [35].…”

Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Long-Term Cardiac Mortality in Heart Failure with Reduced Ejection Fraction

“…1 ARNI also reduces new-onset atrial fibrillation (AF) incidence by lowering the left atrial strain and significantly increasing reverse remodeling after myocardial infarction (MI). 8,9…”

Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias

“…In HFrEF patients with cardiac implantable electronic devices (CIEDs), two studies have suggested a lower recurrence of atrial arrhythmias, reduced atrial arrhythmia burden and fewer ventricular extrasystoles in patients with non-permanent AF treated with sacubitril/valsartan [38,39]. However, this reduction in AF burden was not observed in another study [40].…”