Myocardial work improvement after sacubitril–valsartan therapy: a new echocardiographic parameter for a new treatment

Abstract

Aims Myocardial work is a new transthoracic echocardiogram (TTE) parameter that enhances the information provided through left ventricular (LV) global longitudinal strain (GLS). Nothing is known about the impact of sacubitril/valsartan (LCZ696) therapy on myocardial work parameters. The aim of this study was to evaluate the effects of LCZ696 on LV myocardial work in heart failure patients. Methods Prospective evaluation of chronic heart failure patients with LV ejection fraction of 40% or less despite optimized standard of care therapy, in which LCZ696 therapy was started and no other heart failure treatment was expected to change. TTE study was performed before and 6 months after LCZ696 therapy. A semiautomated analysis of LV GLS was made and myocardial work estimated using custom software of the GE Vivid E95 ultrasound system. Results Of the 42 patients, 35 (83.3%) completed the 6 months, follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment due to adverse events. Mean age was 58.6 ± 11.1 years. TTE data showed a significant reduction in LV dimensions and atrial volumes, as well as an improvement in LV ejection fraction (29.3 vs. 35.2%, P = 0.001) and GLS (−7.0 vs. −8.9%, P = 0.001). Myocardial work had a significant increase in global constructive work (720.2 vs. 900.6 mmHg%, P = 0.016) and global work efficiency (78.6 vs. 86.6%, P = 0.027), with a nonsignificant decrease in global wasted work (150.2 vs. 136.8 mmHg%, P = 0.441) at 6 months. Conclusion LCZ696 therapy was associated with signs of reverse remodelling by usual TTE parameters and LV myocardial work at 6 months, including an increase in global constructive work and work efficiency.

Myocardial Work by Speckle Tracking Echocardiography Accurately Assesses Left Ventricular Function of Coronary Artery Disease Patients

“…Recent studies reported that MW showed distinct patterns in different afterload conditions and settings (4)(5)(6)(7)(8). LVEF is usually preserved in the early stages of cardiovascular diseases (9).…”

The non-invasive assessment of myocardial work by pressure-strain analysis: clinical applications

“…Heart failure patients with reduced ejection fraction treated with sacubitril/valsartan showed signs of LV reverse remodeling by common echocardiographic parameters as well as a significant improvement of constructive work and myocardial work efficiency during a follow up of 12 months. Wasted work, on the contrary, did not appear to be greatly affected [83,84]. Also, GCW could predict long-term outcome in patients with HFrEF receiving sacubitril/valsartan.…”

Left Ventricular Systolic Function After 3 Months of SGLT2 Inhibitor Therapy in Heart Failure Patients with Reduced Ejection Fraction

“…Their study showed a greater increase in GWI among patients using GLP-1RA or a combination of GLP-1RA and SGLT2i compared with insulin-only users [ 15 ]. In addition, myocardial work indices were used to evaluate the therapeutic effect when sacubitril/valsartan was added to BB and MRA during 6 months of therapy and showed an improvement in GCW and GWE [ 16 , 17 ]. Therefore, to the best of our knowledge, the present study is the first to investigate and quantify the effects of adding SGLT2i to maximally optimized medical therapy, consisting of sacubitril/valsartan, MRA, and BB, on myocardial work indices in the population of ambulatory HFrEF patients.…”