Effects of sacubitril/valsartan on clinical symptoms, echocardiographic parameters, and outcomes in HFrEF and HFmrEF patients with coronary heart disease and chronic kidney disease

Raphael, Dominick Mkombozi; Liu, Zhiyu; Jin, Zhi; Cui, Xinyue; Han, Donglin; He, Wei; Shangguan, Jiahong; Shen, Deliang

doi:10.1080/03007995.2021.1908243

Cited by 5 publications

(9 citation statements)

References 33 publications

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“…39,40 However, AF was associated with a higher incidence of cardiovascular death in HFrEF patients who were medicated with sacubitril/valsartan. 41 In this regard, AF could be a risk factor for worse treatment efficacy in obese patients. Furthermore, the impact of sacubitril/valsartan on ventricular tachyarrhythmias has been observed.…”

Section: Discussionmentioning

confidence: 99%

Incidence of atrial and ventricular arrhythmias in obese patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan

Abumayyaleh

Demmer

Krack

et al. 2023

Diabetes Obesity Metabolism

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AimTo compare clinical outcomes among patients with heart failure and reduced ejection fraction (HFrEF) according to body mass index (BMI) after initiating treatment with an angiotensin‐receptor neprilysin inhibitor (ARNI).MethodsWe gathered data from 2016 to 2020 at the University Medical Center Mannheim; 208 consecutive patients were divided into two groups according to BMI (< 30 kg/m2; n = 116, ≥ 30 kg/m2; n = 92). Clinical outcomes, including mortality rate, all‐cause hospitalizations and congestion, were systematically analysed.ResultsAt the 12‐month follow‐up, the mortality rate was similar in both groups (7.9% in BMI < 30 kg/m2 vs. 5.6% in BMI ≥ 30 kg/m2; P = .76). All‐cause hospitalization before ARNI treatment was comparable in both groups (63.8% in BMI < 30 kg/m2 vs. 57.6% in BMI ≥ 30 kg/m2; P = .69). After ARNI treatment, the hospitalization rate was also comparable in both groups at the 12‐month follow‐up (52.2% in BMI < 30 kg/m2 vs. 53.7% in BMI ≥ 30 kg/m2; P = .73). Obese patients experienced more congestion compared with non‐obese patients at follow‐up, without statistical significance (6.8% in BMI < 30 kg/m2 vs. 15.5% in BMI ≥ 30 kg/m2; P = .11). Median left ventricular ejection fraction (LVEF) improved in both groups, but significantly more in non‐obese compared with obese patients at the 12‐month follow‐up (from 26% [3%‐45%] [min.‐max.] vs. 29% [10%‐45%] [min.‐max.] [P = .56] to 35.5% [15%‐59%] [min.‐max.] vs. 30% [13%‐50%] [min.‐max.] [P = .03], respectively). The incidence of atrial fibrillation (AF), non‐sustained (ns) and sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) was less in non‐obese than in obese patients after initiation of sacubitril/valsartan at the 12‐month follow‐up (AF: 43.5% vs. 53.7%; P = .20; nsVT: 9.8% vs. 28.4%; P = .01; VT: 14.1% vs. 17.9%; P = .52; VF: 7.6% vs. 13.4%; P = .23).ConclusionsThe incidence of congestion in obese patients was higher compared with non‐obese patients. LVEF improved significantly more in non‐obese compared with obese HFrEF patients. Furthermore, AF and the ventricular tachyarrhythmia rate were revealed more in obesity compared with those without obesity at the 12‐month follow‐up.

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Section: Discussionmentioning

confidence: 99%

Incidence of atrial and ventricular arrhythmias in obese patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan

Abumayyaleh

Demmer

Krack

et al. 2023

Diabetes Obesity Metabolism

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“…The RAAS and adrenergic system are activated; the activated RAAS results in increases sodium and water retention, while activated adrenergic system which leads to increased left ventricular contractility and vasoconstriction [10][11]. Neuroendocrine is started to meet cardiac output demand, but continuous activation results in poor adaptation and cardiac remodeling; these, affects Left ventricular function ability to meet metabolizing tissue demands [12]. The free circulating levels of angiotensin-II have been shown to increase in heart failure patients, which impacts cell function, impair intrinsic myocardial contractility, increase ventricular stiffness, and impair diastolic function [13].…”

Section: A) Pathophysiology Of Heart Failure and Consequences Of Redu...mentioning

confidence: 99%

“…On examination he was obese grade 2, with high Blood Pressure 170/92mmHg, Pulse Rate 110bpm (60-102), lower limb edema grade 3, elevated jugular venous pressure (JVP 7cm), Apex beat on the 5intercostal space lateral to the midclavicular line, S3-Gallops sound, bilateral basal coarse crepitation, and anterior crackles. His Laboratory workup reveals elevated FBG 150.3mg/dl (65-95mg/dl), Hb1AC 7.7 % (˂5.7%), LDL-C 160mg/dl (62-130mg/dl), Total cholesterol 230mg/dl(0-200mg/dl), HDL-C 21mg/dl(˂40-0mg/dl), Hemoglobin(Hb) 15.4g/dl (13.3-16.2), white blood cell (WBC) 5.0 X1000/mcL (3.54-9.06), serum Creatinine 1.3mg/dl(0.5-1.5mg/dl), BUN 15mg/dl (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), Potassium 4.0mmol/L(3.5-5.0), Sodium 139mmol/L, ALT(SGPT) 15U/L(7-41), AST(SGOT) 24U/L The patient was diagnosed with Heart Failure, reduced Ejection Fraction [HFrEF] NYHA Class III with Diastolic failure grade III, T2DM, and dyslipidemia. He was kept on IV Furosemide 80mg 6hrly, and then he had a weight loss of more than 1.5kg, and urine output was 5L/day.…”

Section: Patient Historymentioning

confidence: 99%

“…At six months (24weeks follow up) the baseline was performed; Blood Pressure 135/98mmHg, Pulse rate 69bpm, FBG 78.1mg/dl (65-95mg/dl), Hb1AC 5.2 % (˂5.7%), LDL-C 85mg/dl (62-130mg/dl), and Total cholesterol 190mg/dl(0-200mg/dl), HDL-C 37mg/dl(˂40-0mg/dl), Hemoglobin(Hb) 13.4g/dl(13.3-16.2), Mean Corpuscular Volume (MCV) 86.4fL(79-93.3), Ferritin 150(0-300) white blood cell (WBC) 4.8 X1000/mcL (3.54-9.06), serum Creatinine 1.4mg/dl(0.5-1.5mg/dl), BUN 10mg/dl (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), Potassium 4.9mmol/L(3.5-5.0), Sodium 140mmol/L(136-146), ALT(SGPT) 21U/L(7-41), AST(SGOT) 22U/L(12-38) ), at echocardiography, left ventricular end-diastolic dimension (LVEDD) was 46mm, lateral wall akinesia, and left ventricular ejection fraction (LVEF) was increased to 35%, TAPSE 18, mild mitral insufficiency was found, mild tricuspid insufficiency, and the left atrium was mild enlarged, LAVI 38.0ml/m 2 . The inferior vena cava (IVC) was normal.…”

Section: Patient Historymentioning

confidence: 99%

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Theuse of LCZ-696(Sacubitril/Valsartan) and SGLT2inhibitors: A Real World Experience in a Rural African Patient with Heart Failure with Reduced Ejection Fraction (HFrEF). A Case Series

Raphael¹,

Makuka²,

Mogella³

et al. 2023

GJMR

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Objective: To observe the outcomes of the use of both Angiotensin Receptor-Neprilysin inhibitor (ARNI) and sodium-glucose cotransport 2-inhibitor (SGLT2Ii) in terms of echocardiographic parameters, clinical symptoms, cardiovascular death, and Heart failure hospitalization in patient with heart failure reduced ejection fraction (HFrEF) in the hard-to-reach rural area of Africa. Background: Angiotensin Receptor-Neprilysin inhibitor (ARNI) is preferred over angiotensin-converting enzymes inhibitor or an angiotensin II receptor blocker as foundation therapy for patients with heart failure with reduced ejection fraction to reduce the risk of cardiovascular death, Heart failure hospitalization, and Heart failure symptoms. SGLT2 inhibitor (Dapagliflozin and Empagliflozin) is among the four foundation drugs in managing HFrEF.

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“…Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI), which can elevate natriuretic peptide and inhibit angiotensin II to protect cardiac function ( 6 ). Recent studies have shown that sacubitril/valsartan can significantly improve the symptoms of HF ( 7 ) and stabilize renal function ( 8 ). Besides, it can improve the quality of life of patients with CRS.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Sacubitril/Valsartan Treatment on Cardiac and Renal Functions of a Patient With Cardiorenal Syndrome Type 4 and Stage 5 CKD After More Than Three Years of Follow-Up

et al. 2022

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It is difficult to treat cardiorenal syndrome (CRS) in clinical practice, which is the common reason for the death of patients. This report aimed to describe the effects of sacubitril/valsartan treatment on cardiac and renal functions of a patient with cardiorenal syndrome type 4 (CRS4) after more than 3 years of follow-up. A 77-year-old Chinese woman was admitted to our hospital because of CRS4 and stage 5 chronic kidney disease (CKD), who had a history of long-term proteinuria and renal failure. The patient's cardiothoracic ratio (CTR) measured by chest X–ray was 0.6. Cardiac ultrasonography showed that the left ventricular ejection fraction (LVEF) was 0.40. The patient had been treated for heart failure (HF) for 5 months, but there was no improvement in clinical manifestations, and the renal function gradually deteriorated. In our hospital, she received sacubitril/valsartan treatment for at least 40 months. The symptoms of HF relieved, and the indices of cardiac function improved. In addition, the patient's renal function was stable. During the treatment, the dosage of sacubitril/valsartan needed to be adjusted to achieve the optimal therapeutic effect. Follow-up results showed that she achieved cardiac function of New York Heart Association (NYHA) class II with an ejection fraction of 0.60 and E/A > 1 indicated by echocardiogram, and did not develop hyperkalemia. In summary, the improvement of cardiac and renal functions of the CRS4 patient was associated with the long-term sacubitril/valsartan treatment.

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Effects of sacubitril/valsartan on clinical symptoms, echocardiographic parameters, and outcomes in HFrEF and HFmrEF patients with coronary heart disease and chronic kidney disease

Cited by 5 publications

References 33 publications

Incidence of atrial and ventricular arrhythmias in obese patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan

Incidence of atrial and ventricular arrhythmias in obese patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan

Theuse of LCZ-696(Sacubitril/Valsartan) and SGLT2inhibitors: A Real World Experience in a Rural African Patient with Heart Failure with Reduced Ejection Fraction (HFrEF). A Case Series

The Effect of Sacubitril/Valsartan Treatment on Cardiac and Renal Functions of a Patient With Cardiorenal Syndrome Type 4 and Stage 5 CKD After More Than Three Years of Follow-Up

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