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

Abstract

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.

Sacubitril/Valsartan in the Treatment of Right Ventricular Dysfunction in Patients With Heart Failure With Reduced Ejection Fraction: A Real-world Study

“… 13 In a similar cohort in China, only 31% of patients prescribed sacubitril/valsartan at a maximum dose of 49/51 mg twice daily after 1-year assessment. 14 In our study, 27% of patients ultimately achieved the dose of 49/51 mg twice daily after 6 months. A recent research preliminarily observed that the optimally effective and tolerated dose among Chinese patients with HFrEF was possibly lower than that among Western patients.…”

“…A recent research preliminarily observed that the optimally effective and tolerated dose among Chinese patients with HFrEF was possibly lower than that among Western patients. 14 This might be attributable to differences in genetic and clinical characteristics and medical treatment of patients with HFrEF between China and other areas of the world. 15 Therefore, more studies are required to further investigate and optimize dose management of sacubitril/valsartan for Chinese patients with HF.…”

Striking a Balance Between eGFR Decline and LVEF Improvement in Asian Patients with Heart Failure Treated with Sacubitril/Valsartan

“…Therefore, an indicator for quantitatively assessing a patient's therapeutic response would help clinicians decide whether and how much to adjust the patient's dosage of sacubitril/valsartan [36]. Moreover, a study involving Chinese patients reported a substantial reduction in renal function and increased prevalence of CKD after a median follow-up of 365 days [37]. These ndings highlight the concerning possibility that patients who are nonresponsive to sacubitril/valsartan may deriving more harm than bene t from taking the medication.…”

Sacubitril Valsartan Enhances Cardiac Function and Alleviates Myocardial Infarction in Rats through a SUV39H1/SPP1 Axis

“…In the PIONEER-HF trial, early treatment of lcz696 in patients with MI reduced the level of N-terminal pro-B-type natriuretic peptide and alleviated LV systolic dysfunction [ 24 ]. The PARADISE-AMI study also showed that patients with acute MI benefit from the lcz696 treatment [ 25 ], and studies are emerging to analyze the treating effect of lcz696 on MI and heart failure [ 15 , 26 ]. Moreover, several studies reported that the molecular changes are involved in the biofunctions of lcz696.…”