Effects of angiotensin receptor neprilysin inhibition on pulmonary arterial stiffness in heart failure with reduced ejection fraction

Yenerçağ, Mustafa; Arslan, Uğur; Dereli, Seçkin; Çoksevim, Metin; Doğduş, Mustafa; Kaya, Ahmet

doi:10.1007/s10554-020-01973-8

Cited by 17 publications

(18 citation statements)

References 29 publications

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“…The mean follow‐up duration ranged from 3 to 17.1 months. Of the 10 included studies, 6 13 , 15 , 22 , 23 , 24 , 25 were prospective, and 4 14 , 26 , 27 , 28 were retrospective. One study 24 had a control group that received angiotensin‐converting enzyme inhibitor, whereas the others had no control group.…”

Section: Resultsmentioning

confidence: 99%

“…Because it was not meaningful to analyze the only study 24 with a control group separately, we decided to extract the experimental group data from it. Six studies 13 , 14 , 22 , 23 , 26 , 27 were from Italy, one 28 was from Turkey, one 15 was from France, one 24 was from Greece, and one 25 was from Slovenia.…”

Section: Resultsmentioning

confidence: 99%

“…The Newcastle‐Ottawa scale scores of the included studies are shown in Table S1 , ranging from 6 to 9. Most included studies 13 , 14 , 15 , 22 , 23 , 25 , 26 , 27 , 28 had a moderate risk of bias because of the lack of a control group, 4 14 , 26 , 27 , 28 of which had a higher risk of bias because of the nature of the retrospective studies. The risk of bias was shown to be low in only one study.…”

Section: Resultsmentioning

confidence: 99%

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Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies

Zhang

Qin

et al. 2022

JAHA

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Background Sacubitril/valsartan (S/V) demonstrated significant effects in improving left ventricular performance and remodeling in patients with heart failure with reduced ejection fraction. However, its effects on the right ventricle remain unclear. This systematic review and meta‐analysis aimed to assess the impact of S/V on right ventricular function and pulmonary hypertension. Methods and Results We searched PubMed, Embase, Cochrane Library, and Web of Science from January 2010 to April 2021 for studies reporting right ventricular and pulmonary pressure indexes following S/V treatment. The quality of included studies was assessed using the Newcastle‐Ottawa scale. Variables were pooled using a random‐effects model to estimate weighted mean differences with 95% CIs. We identified 10 eligible studies comprising 875 patients with heart failure with reduced ejection fraction (mean age, 62.2 years; 74.0% men), all of which were observational. Significant improvements on right ventricular function and pulmonary hypertension after S/V initiation were observed, including tricuspid annular plane systolic excursion (weighted mean difference, 1.26 mm; 95% CI, 0.33–2.18 mm; P =0.008), tricuspid annular peak systolic velocity (weighted mean difference, 0.85 cm/s; 95% CI, 0.25–1.45 cm/s; P =0.005), and systolic pulmonary arterial pressure (weighted mean difference, 7.21 mm Hg; 95% CI, 5.38–9.03 mm Hg; P <0.001). Besides, S/V had a significant beneficial impact on left heart function, which was consistent with previous studies. The quadratic regression model revealed a certain correlation between tricuspid annular plane systolic excursion and left ventricular ejection fraction after excluding the inappropriate data ( P =0.026). Conclusions This meta‐analysis verified that S/V could improve right ventricular performance and pulmonary hypertension in heart failure with reduced ejection fraction, which did not seem to be fully dependent on the reverse remodeling of left ventricle. Registration URL: https://www.crd.york.ac.uk/prospero ; Unique identifier: CRD42021247970.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies

Zhang

Qin

et al. 2022

JAHA

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“…26 According to the previous studies, although it is demonstrated and observed in practice that sacubitril/valsartan decreases pulmonary pressures, Correale et al 12 were the only researchers to have recently prospectively shown the associated improvement in RV function in regard to TAPSE. 10,11,13,27 Yenerçağ et al 28 retrospectively showed the significant increase of TAPSE, FAC and MPI at 6-month follow-up. Supposedly, studies that did not show any significant RV improvement did not have follow-up long enough.…”

Section: Improvement Of Rv-functional Parameters With Sacubitril/valsartanmentioning

confidence: 99%

Impact of sacubitril/valsartan on systolic heart failure: Right heart location and clustering analysis

Bouali¹,

Galli²,

Paven³

et al. 2021

Adv Clin Exp Med

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Background. Heart failure with reduced ejection fraction (HFrEF) is a heterogeneous syndrome. In heart failure (HF) classifications, right ventricle (RV) function was for a long time unrecognized in favor of left ventricular ejection fraction (LVEF). The response to sacubitril/valsartan might differ according to phenotypes and the impact of right ventricular characteristics on this response remains controversial.Objectives. First, we applied clustering analysis in a HFrEF population undergoing sacubitril/valsartan treatment according to guidelines, to identify phenotypes and their associated clinical outcomes. Secondly, we evaluated RV-remodeling. Materials and methods.It is a prospective, observational, single-center study conducted on 108 symptomatic patients (mean age 66 ±12.8 years, 22.2% women). First, the clustering analysis was applied in a HFrEF population undergoing sacubitril/valsartan treatment, according to the guidelines, in order to identify phenotypes and clinical outcomes associated with them. Secondly, we evaluated RV-remodeling.Results. Two distinct clusters were identified. Among the differences between phenotypes, RV (tricuspid annular plane systolic excursion (TAPSE) 16 ±4 mm compared to 19 ±4 mm, p < 0.001; RV free wall strain −19 ±5% compared to −21 ±4%, p = 0.046; RV fraction area change (FAC) 31 ±9% compared to 38 ±9%, p < 0.001), LV-filling pressure (E-wave deceleration time 138 (median: 41) ms compared to 180 (median: 94) ms, p < 0.001; E/e' 16.7 (median: 8.0) ms compared to 13.0 (median: 9.7) ms, p = 0.02) and creatinine level (106 ±34 µmol/L compared to 90 ±19 µmol/L, p = 0.002) were substantially different at the initiation of therapy. Major adverse cardiac events (MACEs) or death occurred in 38 out of 107 patients: 51. 1% in cluster 1 compared to 24.2% in cluster 2 (p = 0.0074). A significant improvement in RV-functional parameters was observed under treatment. The TAPSE improved and correlated with the change in left ventricular (LV) function. Yet, it did not correlate with systolic pulmonary artery pressure (sPAP) and LV end-diastolic diameter.Conclusions. The HFrEF phenotype characterized by more severe RV dysfunction has a worse prognosis during sacubitril/valsartan therapy. Both RV-and LV functions significantly improve when the patient is treated with sacubitril/valsartan.

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“…Our findings, however, are in line with previous studies. In patients with HFrEF,Masarone et al (2020) demonstrated that S/V may improve RV-pulmonary artery coupling;Landolfo et al (2020) showed a PAsP improvement after S/V therapy andYenerçağ et al (2021) …”

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confidence: 98%

Predictors of right ventricular function improvement with sacubitril/valsartan in a real‐life population of patients with chronic heart failure

Correale

Mazzeo

Magnesa

et al. 2021

Clin Physio Funct Imaging

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Background Observational studies have demonstrated that treatment with sacubitril/valsartan may improve left ventricular (LV) systolic and diastolic function in subjects with reduced LV ejection fraction (LVEF) in real‐world studies. Subjects with heart failure and reduced EF (HFrEF), however, are also characterized by an impaired right ventricular (RV) function. We therefore aimed to evaluate whether also RV function may improve after S/V therapy and possible predictors of RV improvement could be identified at echocardiography and tissue Doppler imaging. Methods Fifty consecutive patients (67 ± 8 years, LVEF 28 ± 6%, male 86%) with chronic HFrEF and NYHA class II‐III were followed up for 6 months after therapy with S/V. LV&RV function was assessed at baseline and after 6 months of therapy. Results After 6‐month therapy with S/V a significant improvement was shown in the following echocardiography parameters assessing RV function: PAsP (31 ± 11 vs. 35 ± 10 mmHg, p < 0.001), TAPSE (19 ± 3 vs. 18 ± 3 mm, p < 0.001), RV FAC (38 ± 7 vs. 34 ± 6 mm, p < 0.001), RV S’ (12 ± 2 vs. 10 ± 2 cm/s, p < 0.001), RV‐FW‐LS (−20 ± 5 vs. −18 ± 5%, p < 0.001), RV‐4Ch‐LS (−16 ± 5 vs. −14 ± 5%, p < 0.001). At multivariable analysis improvement in RV‐FW‐LS was associated to baseline levels of RV S’ (r 0.75, p < 0.01) and RAV (r –0.32, p < 0.05). Conclusions In a real‐world scenario, 6‐month therapy with S/V was associated with an improved RV function in HFrEF. RV function improvement may be predicted by assessing baseline RV S’ and right atrial volume values.

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Effects of angiotensin receptor neprilysin inhibition on pulmonary arterial stiffness in heart failure with reduced ejection fraction

Cited by 17 publications

References 29 publications

Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies

Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies

Impact of sacubitril/valsartan on systolic heart failure: Right heart location and clustering analysis

Predictors of right ventricular function improvement with sacubitril/valsartan in a real‐life population of patients with chronic heart failure

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