Sacubitril/valsartan improves both functional and echocardiographic parameters in patients with chronic heart failure with reduced ejection fraction

Cosentino, Eugenio Roberto; Esposti, Daniela Degli; Miceli, Rinaldo; Bentivenga, Crescenzio; Landolfo, Matteo; Cicero, Arrigo F G; Berardi, E.; Spinardi, Luca; Magri, G; Dugato, Vittorio; Borghi, Claudio

doi:10.1080/03007995.2019.1576481

Cited by 19 publications

(15 citation statements)

References 12 publications

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“…Cosentino et al discovered sacubitril/valsartan was well tolerated with stable blood pressure if correctly titrated, with no need for drug withdrawal and/or dose tapering. 6 Martens et al reported that hypotension was the main reason for no further up-titration of sacubitril/valsartan (50%), but no discontinuation of sacubitril/valsartan occurred. 4 Likewise, 15 patients (15%) occurred hypotension (SBP < 100 mmHg), and two patients (2%) had serum potassium level of more than 5.5 mmol/L in our study, but no patients stopped sacubitril/valsartan over the entire treatment period.…”

Section: Discussionmentioning

confidence: 99%

Sacubitril/valsartan improves cardiac function in Chinese patients with heart failure: a real‐world study

Chen

Liu

et al. 2021

ESC Heart Failure

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Aims Sacubitril/valsartan significantly reduced heart failure (HF) hospitalization and cardiovascular mortality in a randomized controlled trial. However, little is known about real-world efficacy and safety of sacubitril/valsartan in Chinese patients with HF with reduced ejection fraction (HFrEF). We aimed to evaluate whether sacubitril/valsartan could improve cardiac function in Chinese patients with HFrEF in a tertiary hospital in China. Methods and results Patients with HFrEF receiving sacubitril/valsartan in our hospital between January 2018 and January 2020 were recruited in the present study. We retrospectively collected and analysed all clinical parameters at baseline and during follow-up. A total of 100 consecutive patients (73% male) with HFrEF were recruited in the present study. During a median follow-up period of 365 days [interquartile range (IQR), 346-378], a pronounced improvement of cardiac function was achieved. New York Heart Association classification was significantly improved (P < 0.001), and median N-terminal pro-B-type natriuretic peptides level significantly decreased from 3003 pg/mL (IQR, 1513-5404) to 2039 pg/mL (IQR, 921-3955) (P = 0.010). Mean left ventricular ejection fraction increased from 31 ± 6% to 38 ± 10% (P < 0.001) and median left ventricular end-diastolic diameter reduced from 63 mm (IQR, 59-67) to 60 mm (IQR, 55-68) (P = 0.001). Mean pulmonary arterial systolic pressure decreased significantly from 49 ± 13 mmHg to 44 ± 12 mmHg (P < 0.001) and median right ventricular end-diastolic diameter reduced from 23 mm (IQR, 21-26) to 22 mm (IQR, 20-25) (P = 0.030). After treatment with sacubitril/valsartan, mean estimated glomerular filtration rate significantly decreased (from 88.8 ± 22.4 mL/min to 71.8 ± 27.3 mL/min, P < 0.001). Median serum creatinine and median blood urea nitrogen levels significantly increased [from 0.9 mg/dL (IQR, 0.8-1.0) to 1.1 mg/dL (IQR, 0.9-1.3), P < 0.001, and from 6.8 mmol/L (IQR, 5.5-8.9) to 8.0 mmol/L (IQR, 6.6-10.3), P = 0.002, respectively]. The proportion of patients with chronic kidney disease Stage 3/4 increased significantly from 8% to 39% (P < 0.001). Conclusions In Chinese patients with HFrEF, sacubitril/valsartan treatment was associated with a pronounced improvement of cardiac function, but might be prone to a decrease in blood pressure and deterioration in renal function.

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Section: Discussionmentioning

confidence: 99%

Sacubitril/valsartan improves cardiac function in Chinese patients with heart failure: a real‐world study

Chen

Liu

et al. 2021

ESC Heart Failure

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“…The potential reverse remodelling effect of sac/val has been demonstrated in the PRIME study, a prospective randomized trial showing that sac/val is more effective than the only angiotensin receptor blocker to improve functional mitral regurgitation HF associated after 12 months of follow-up, without significant changes in LVEF (Kang DH, et al, 2019). Moreover, several real world evidence studies have reported an improvement of cardiac remodelling markers and patients' functional capacity (Spannella F, et al, 2019;Moliner-Abós C, et al, 2019;Wachter R, et al, 2019;Haddad H, et al, 2020;Mentz RJ, et al, 2020;Correale M, et al, 2020;Cosentino et al, 2019;Martens P, et al, 2018). In particular, a retrospective cohort study on a small number of HFrEF patients showed, after a mean follow-up of 14 months, a significant improvement in LVEF and GLS (De Vecchis R, et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…In particular, a retrospective cohort study on a small number of HFrEF patients showed, after a mean follow-up of 14 months, a significant improvement in LVEF and GLS (De Vecchis R, et al, 2019). Among prospective studies, short term evaluations demonstrated a significant improvement in LV remodelling markers, including a betterment of mitral filling pattern (Martens P, et al, 2018) together with clinical and functional parameters (Cosentino et al, 2019). Recently, Castrichini et al demonstrated that the introduction of sac/val in HFrEF, despite a long history of disease, provides a global LV and LA reverse remodeling in more than 25% of cases, both at standard and advanced echocardiographic evaluations, after a median follow-up of 9 months.…”

Section: Discussionmentioning

confidence: 99%

Impact of Sacubitril/Valsartan on Clinical and Echocardiographic Parameters in Heart Failure Patients With Reduced Ejection Fraction: Data From a Real Life 2-year Follow-Up Study

et al. 2021

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Heart failure (HF) represents a widespread health problem characterized by high morbidity and mortality. Sacubitril/Valsartan (sac/val) has improved clinical prognosis in patients affected by HF with reduced ejection fraction (HFrEF). The aim of this study was to evaluate the effectiveness and durability of sac/val treatment on the clinical, hemodynamic and echocardiographic parameters, in real-life consecutive HFrEF outpatients, evaluated up to 2-years of follow-up. We collected 300 repeated observations over time in 60 patients suffering of HFrEF and symptomatic despite optimal drug therapy. Patients with left ventricular ejection fraction (LVEF) <35 and II-III NYHA functional class were considered. All patients underwent to clinical-instrumental and laboratory determinations and Minnesota Living with HF Questionnaire (MLHFQ) every 6 months until 24 months to evaluate possible clinical benefits and adverse events. During a 2-year follow-up period and through a 6-monthly control of the study variables both clinical, hemodynamic, biochemical and echocardiographic parameters significantly improved, in particular cardiac index (CI), both atrial and ventricular volumes and global longitudinal strain (GLS). Furthermore, there was a reduction of NT-proBNP levels and betterment of renal function and NYHA functional class, demonstrating the efficacy and durability of sac/val treatment. In a multiple linear mixed model the longitudinal evolutions of CI were associated to concomitant changes of GLS and E/e’ ratio. Our study, contemplating the collection of 300 repeated observations in 60 patients, provides a complete and detailed demonstration of sac/val effects, showing effectiveness, safety and effect durability of the treatment every 6 months up to 2-years of follow-up with significant improvement of several clinical, hemodynamic and echocardiographic parameters in HFrEF outpatients.

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“…Post hoc analysis of the PARADIGM‐HF study showed an improvement in patient quality of life (QoL) as scored by the Kansas City Cardiomyopathy Questionnaire 12,13 . In addition, only a few other studies have explored the evidence gap of tolerability and efficacy of sacubitril/valsartan in an intention to treat real world setting 14,15 . These studies have shown improvement in NYHA functional class within 3–6 months of commencement of sacubitril/valsartan.…”

Section: Introductionmentioning

confidence: 99%

Tolerability and efficacy of sacubitril/valsartan in clinical practice

Nandal

Chow

Hannah

et al. 2021

Internal Medicine Journal

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Background Heart failure (HF) is a major cause of morbidity and mortality. Sacubitril/valsartan has demonstrated reductions in HF hospitalisation, and all‐cause mortality in patients with heart failure with reduced ejection fraction. Aims To assess the tolerability and efficacy of sacubitril/valsartan in an intention to treat patient cohort. Methods Sixty‐five patients who were commenced on sacubitril/valsartan in 2017 at a major metropolitan centre in Victoria were retrospectively audited. Clinical outcomes and quality of life scores were obtained pre and post sacubitril/valsartan commencement through phone and regular clinic follow up, 6–12 months after commencement of sacubitril/valsartan. Results Fourteen percent of patients were able to achieve maximal dose (97/103 mg twice daily) whilst 37% remained on 49/51 mg and 23% on 24/26 mg. The mean systolic blood pressure reduced from 118 ± 18 mmHg to 109 ± 15 mmHg with symptomatic hypotension (30%) being the most common side‐effect leading to dose reduction or drug cessation. Left ventricular ejection fraction improved from 29.1 ± 9.7% to 33.8 ± 9.9% (P < 0.05) on drug. There was also a significant improvement in quality of life scores; EQ5D‐VAS 40 pre versus 67 post sacubitril/valsartan (P < 0.05), and New York Heart Association class (P < 0.05). Importantly, 10 patients lost an existing indication for device based therapy after treatment with sacubitril/valsartan. Conclusions Sacubitril/valsartan is a much needed therapeutic advancement in the treatment of HF. Our study indicates it is well tolerated with improvements in cardiac function and symptoms. Sacubitril/valsartan could redefine the definition of ‘optimal medical therapy’ when assessing patients for device based therapies.

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Sacubitril/valsartan improves both functional and echocardiographic parameters in patients with chronic heart failure with reduced ejection fraction

Cited by 19 publications

References 12 publications

Sacubitril/valsartan improves cardiac function in Chinese patients with heart failure: a real‐world study

Sacubitril/valsartan improves cardiac function in Chinese patients with heart failure: a real‐world study

Impact of Sacubitril/Valsartan on Clinical and Echocardiographic Parameters in Heart Failure Patients With Reduced Ejection Fraction: Data From a Real Life 2-year Follow-Up Study

Tolerability and efficacy of sacubitril/valsartan in clinical practice

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