Effects of sacubitril valsartan on clinical and echocardiographic parameters of outpatients with heart failure and reduced ejection fraction

Landolfo, Matteo; Piani, Federica; Esposti, Daniela Degli; Cosentino, Eugenio Roberto; Bacchelli, Stefano; Dormi, Ada; Borghi, Claudio

doi:10.1016/j.ijcha.2020.100656

Cited by 19 publications

(26 citation statements)

References 26 publications

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“…Even if the magnitude of ARNI-related reverse remodelling described in previous studies is inferior to that observed in our case, [15][16][17] , other studies showed more considerable changes of left ventricular volumes and ejection fraction. 12,18,19 Moreover, in the present case the observed changes of left ventricular volumes and ejection fraction improvement were rapid, similarly to other reports describing significant reverse remodelling only after switching from standard therapy to sacubitril/valsartan in patients with cardiotoxicity. 20 In conclusion, in this case report of relapsing HCL and HFrEF, early ARNI treatment was feasible, safe and accompanied by significant LVEF improvement.…”

Section: Discussionsupporting

confidence: 89%

Sacubitril/Valsartan to Treat Heart Failure in a Patient with Relapsing Hairy Cell Leukaemia: Case Report

Lupi¹,

Ariotti²,

Pace³

et al. 2021

Clin Med Insights Cardiol

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Experience with angiotensin-receptor neprilysin inhibitors (ARNI) in oncologic patients with heart failure (HF) is limited. We report a case of ARNI started as first-choice therapy in a patient with relapsing hairy cell leukaemia (HCL) and HF with depressed left ventricular ejection fraction (LVEF). A middle-aged male, previously treated with rituximab for HCL, was scheduled for cardiologic screening before starting a new antineoplastic therapy for cancer relapse. The patient had symptomatic HF with reduced LVEF and high NT-proBNP levels. In this patient, early ARNI treatment was well tolerated and produced a rapid and durable improvement of symptoms, LVEF and NT-proBNP levels. Consequently, the oncologic team could start an experimental treatment with obinutuzumab, with complete HCL remission. In conclusion, in this patient with HCL and HF, ARNI therapy was safe and effective, contributing to undelayed cancer treatment.

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Section: Discussionsupporting

confidence: 89%

Sacubitril/Valsartan to Treat Heart Failure in a Patient with Relapsing Hairy Cell Leukaemia: Case Report

Lupi¹,

Ariotti²,

Pace³

et al. 2021

Clin Med Insights Cardiol

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“…Growing evidence has emerged of the role of S/V in modifying the clinical course of HFrEF patients, through its modulation of neurohormonal imbalance [2]. The effect of S/V on left chambers' remodelling has been previously demonstrated by traditional 2D TTE [1,[3][4][5][6][7]23] and speckle tracking analysis [5]. On the contrary, there is a paucity of data on the impact of S/V on RV dimensions and function, which are based exclusively on 2D echocardiographic parameters [5,9].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, in the case of previous myocardial infarction, the LV may undergo profound morphological changes with distortion of its 3D shape, which may be unnoticed by 2D echocardiography [27,28]. Although LV reverse remodelling has been described by 2D TTE at mid-and long-term follow-up after S/V initiation in HFrEF patients [1,[3][4][5][6][7]23], only one study conducted subgroup analyses and found no differences in the 2D LVEF improvement between IHD and non-IHD [29]. Such discrepancy from our results may be ascribed to the short followup (3 months) and the low dose of S/V achieved by patients enrolled in the study by Almufleh et al [29].…”

Section: Discussionmentioning

confidence: 99%

“…By inhibiting the renin-angiotensin-aldosterone system [2], sacubitril/valsartan (S/V) is proved to ameliorate left ventricular (LV) volumes, LV systolic [1,[3][4][5][6][7] and diastolic function [5,6,8,9], and long-term prognosis in HFrEF [10][11][12][13]. A few studies, conducted on a limited number of cases, demonstrated an improvement in right ventricular (RV) function by two-dimensional (2D) transthoracic echocardiography (TTE) [5,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Reverse Remodelling by 2D and 3D Echocardiography in Heart Failure Patients Treated with Sacubitril/Valsartan

et al. 2021

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In terms of sacubitril/valsartan (S/V)-induced changes in heart failure with reduced ejection fraction (HFrEF) via three-dimensional (3D) transthoracic echocardiography (TTE) and S/V effects based on HF aetiology, data are lacking. We prospectively enrolled 51 HFrEF patients (24 ischaemic, 27 non-ischaemic). At baseline and at 6-month follow-up (6MFU) after S/V treatment optimisation, we assessed the N-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac remodelling by two-dimensional (2D) and 3DTTE. In non-ischaemic patients, 2D and 3DTTE showed an improvement in left ventricular (LV) size and biventricular function at 6MFU vs. baseline: 3D-LV end-diastolic volume (EDV) 103 ± 30 vs. 125 ± 32 mL/m2 (p < 0.05), 3D-LV ejection fraction (EF) 40 ± 9 vs. 32 ± 5% (p < 0.05), right ventricular (RV) 3D-EF 48.4 ± 6.5 vs. 44.3 ± 7.5% (p < 0.05); only the 3D method detected RV size reduction: 3D-RVEDV 63 ± 27 vs. 71 ± 30 mL/m2 (p < 0.05). In ischaemic patients, only 3DTTE showed biventricular size and LV function improvement: 3D-LVEDV 112 ± 29 vs. 121 ± 27 mL/m2 (p < 0.05), 3D-LVEF 35 ± 6 vs. 32 ± 5% (p < 0.05), 3D-RVEDV 57 ± 11 vs. 63 ± 14 mL/m2 (p < 0.05); RV function did not ameliorate. In both ischaemic and non-ischaemic patients, diastolic function and NT-proBNP significantly improved. In HFrEF patients treated with S/V, 3DTTE helps to ascertain subtle changes in heart chambers’ size and function, which have a major impact on HFrEF prognosis. S/V has significantly different effects on LV function in non-ischaemic vs. ischaemic patients.

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“…Although structural cardiac HFpEF parameters such as left atrial (LA) volume and LV mass should be part of clinical echocardiography for patients with suspected or manifest HF, there may be circumstances when a detailed echocardiographic assessment is unavailable, in geriatric wards or in outpatient clinics with restricted access to echocardiography. In such situations, our results demonstrate that simpler criteria may suffice to identify eligible HFpEF patients 24,25 …”

Section: Discussionmentioning

confidence: 95%

Eligibility of patients with heart failure with preserved ejection fraction for sacubitril/valsartan according to the PARAGON‐HF trial

et al. 2021

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Aims In the heart failure (HF) with preserved ejection fraction (HFpEF) PARAGON‐HF trial, sacubitril/valsartan vs. valsartan improved mortality/morbidity in patients with left ventricular ejection fraction (LVEF) below median (57%). We assessed eligibility for sacubitril/valsartan based on four scenarios. Methods and results Eligibility was assessed in the Karolinska‐Rennes study (acute HFpEF, LVEF ≥ 45%, and N‐terminal pro‐B‐type natriuretic peptide ≥300 pg/mL subsequently assessed as outpatients including echocardiography) in (i) a trial scenario (all trial criteria); (ii) a pragmatic scenario (selected trial criteria); (iii) LVEF below lower limit of normal range (<54% in women and <52% in men); and (iv) LVEF below mean of normal range (<64% in women and <62% in men). Among 425 patients [age 78 (72–83) years, 57% women, 28% LVEF ≤ 57% (median in PARAGON‐HF), the trial scenario, identified 34% as eligible. Left atrial enlargement and/or left ventricular hypertrophy were present in 99%. Inclusion criteria not met were diuretic treatment and New York Heart Association class. Important exclusion criteria were estimated glomerular filtration rate <30 mL/min/1.73 m2, haemoglobin <10 g/day, and cancer. In the pragmatic scenario, 63% were eligible. In LVEF below lower limit of normal range, 5.4% were eligible, and in LVEF below mean of normal range, 41% were eligible. In patients with LVEF ≤ 57%, eligibility was 42%, 69%, 21%, and 91% according to the trial scenario, pragmatic scenario, LVEF below lower limit of normal range, and LVEF below mean of normal range, respectively. Conclusions In real‐world HFpEF (LVEF ≥ 45%) with N‐terminal pro‐B‐type natriuretic peptide and cardiac structure/function assessed, eligibility for sacubitril/valsartan was according to PARAGON‐HF complete criteria 34%, pragmatic criteria 63%, LVEF below lower limit of normal range 5.4%, and LVEF below mean of normal range 41%. Cardiac structural impairment was almost ubiquitous. Ineligibility was more due to exclusion criteria than failing to meet inclusion criteria.

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Effects of sacubitril valsartan on clinical and echocardiographic parameters of outpatients with heart failure and reduced ejection fraction

Cited by 19 publications

References 26 publications

Sacubitril/Valsartan to Treat Heart Failure in a Patient with Relapsing Hairy Cell Leukaemia: Case Report

Sacubitril/Valsartan to Treat Heart Failure in a Patient with Relapsing Hairy Cell Leukaemia: Case Report

Cardiac Reverse Remodelling by 2D and 3D Echocardiography in Heart Failure Patients Treated with Sacubitril/Valsartan

Eligibility of patients with heart failure with preserved ejection fraction for sacubitril/valsartan according to the PARAGON‐HF trial

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