The comparative effects of sacubitril/valsartan versus enalapril on pulmonary hypertension due to heart failure with a reduced ejection fraction

Abstract

The purpose of this study was to investigate the effects of sacubitril/valsartan on right ventricular (RV) function in patients with pulmonary hypertension (PH) due to heart failure with reduced ejection fraction (HFrEF). We prospectively enrolled patients with HFrEF‐induced PH admitted to the Department of Cardiology between August 2018 and December 2019. Patients were randomized to receive oral treatment with sacubitril/valsartan or enalapril. Epidemiological data were recorded before treatment. Echocardiography was performed at admission and 6 months of follow‐up, and all parameters were compared. Major adverse cardiac events (MACEs) were compared between baseline and 6 months follow‐up. There were no significant differences in the baseline characteristics between the two groups. After 6 months of treatment, both treatment groups improved the following parameters from baseline (mean ± SD): left atrium, left ventricle, the left ventricular ejection function (LVEF), RV systolic function (the tricuspid annular plane systolic excursion [TAPSE], the systolic pulmonary artery pressure [sPAP], and TAPSE/sPAP). After 6 months, sacubitril/valsartan improved significantly the following parameters compared with enalapril (all p < 0.05): LVEF (47.07 ± 6.93% vs. 43.47 ± 7.95%); TAPSE (15.33 ± 1.31 vs. 14.78 ± 1.36 mm); sPAP (36.76 ± 14.32 vs. 42.26 ± 12.07 mmHg); and TAPSE/sPAP ratio (0.50 ± 0.23 vs. 0.39 ± 0.14), respectively. There was no difference in readmissions due to recurrent heart failure. Sacubitril/valsartan seems to provide more beneficial effects among patients with HFrEF‐induced PH to improve RV function, along with a decrease in pulmonary pressure.

Clinical and hemodynamic improvement in pulmonary hypertension after switching to sacubitril/valsartan in heart failure patients with preserved ejection fraction

“…Invasive measurement also revealed a significantly reduced mean PCW at follow-up in patients with IpcPH [18 (15-23) mm Hg vs. 21 (18)(19)(20)(21)(22)(23)(24)(25)(26) mm Hg presacubitril/ valsartan, P , 0.01] (Fig. 1), whereas the reduction in mean PCW in patients with CpcPH was only tendential but not statistically significant [16 (10-25) mm Hg vs. 21 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) mm Hg presacubitril/valsartan, P = 0.09] (Fig. 2).…”

“…[12][13][14] Other studies have shown that sacubitril/valsartan reduces pulmonary pressure and improves right ventricular function in patients with heart failure with reduced ejection fraction, which does not seem to depend on reverse of left ventricular remodeling. [15][16][17][18] More recently, 2 small case series have shown that sacubitril/ valsartan also affects PAP in patients with HFpEF, suggesting an effect of sacubitril/valsartan on pulmonary hypertension independent of left ventricular function. 19,20 Therefore, we sought to investigate whether sacubitril/ valsartan affects pulmonary hypertension in a larger cohort of symptomatic patients with HFpEF.…”