Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Masarone, Daniele; Errigo, Vittoria; Melillo, Enrico; Valente, Fabio; Gravino, Rita; Verrengia, Marina; Ammendola, Ernesto; Vastarella, Rossella; Pacileo, Giuseppe

doi:10.3390/jcm9103159

Cited by 20 publications

(38 citation statements)

References 40 publications

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“…At baseline, 97.46% were treated with ACE inhibitors or sartans, 83.9% with beta‐blockers (median heart rate of 70 b.p.m. ), and 64.41% with mineralocorticoid receptor antagonist, as in previous reports 29–33 . After SV initiation, NT‐proBNP values decreased by 30% or more in 51.72% of the whole population (a threshold considered as clinically significant 22,34 ), which is near the 46.3% reported by Pharithi et al 35 .…”

Section: Discussionsupporting

confidence: 78%

Sacubitril‐valsartan initiation in chronic heart failure patients impacts sleep apnea: the ENTRESTO‐SAS study

et al. 2021

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Aims Optimizing medical cardiac treatment for sleep apnoea (SA) in patients with chronic heart failure and reduced ejection fraction (HFrEF) is an expert Grade C recommendation based on six studies encompassing a total of 67 patients only. Whether sacubitril-valsartan (SV), a cornerstone of HFrEF medical treatment, impacts SA is unknown and requires evaluation. Methods and resultsThe ENTRESTO-SAS trial is a six-centre, prospective, open-label real-life cohort study (NCT02916160). Ambulatory patients eligible for SV (i.e. HFrEF adults who remain symptomatic despite optimal treatment) were evaluated before and after 3 months of SV (including nocturnal ventilatory polygraphy); 118 patients were final analysed [median age was 66 (IQ 25-75 : 56-73) years, 81.4% male, 36.5% New York Heart Association III-IV, N-terminal pro-B-type natriuretic peptide level of 1564 (701-3376) ng/L, left ventricular ejection fraction of 30 (25-34)%, 60.7% ischaemic HFrEF, 97.5% initially treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, 83.9% with beta-blockers, 64.4% with mineralocorticoid receptor antagonists, and 74.6% with diuretics]. Three groups were defined according to initial central/obstructive apnoea-hypopnoea indices (AHIs): G1 (n = 49, AHI central ≥ 5/h and AHI obstructive < 15/h); G2 (n = 27, AHI obstructive ≥ 15/h); and G3 (n = 42, AHI central < 5/h and AHI obstructive < 15/h). At 3 months, the AHI (main predefined outcome) decreased significantly by À7.10/h (IQ 25-75 : À16.10 to 0.40; P < 0.001) in G1 + G2 without positive airway pressure treatment (45 patients, median initial AHI of 24.20 (IQ 25-75 : 16.40-43.50)/h). Of these, 24.4% presented an AHI decrease ≥50% and 37.78% had a final AHI < 15/h (tendency for improvement from an initial value of 20%: P = 0.0574). For G1 patients (n = 37), AHI significantly decreased from a median of 22.90 (16.00-43.50)/h to 19.20 (12.70-31.10)/h (P = 0.002). For G2 patients (n = 8), AHI decreased from a median of 30.10 (26.40-47.60)/h to 22.75 (14.60-36.90)/h (statistically non-significant, P = 0.059). Conclusions In this real-life population, SV treatment for 3 months in SA patients is associated with a significant decrease in AHI. These results support the current guidelines that recommend first an optimization of the HFrEF treatment in patients with HFrEF and central SA. A potential positive airway pressure sparing effect merits further investigation.

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Section: Discussionsupporting

confidence: 78%

Sacubitril‐valsartan initiation in chronic heart failure patients impacts sleep apnea: the ENTRESTO‐SAS study

et al. 2021

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“…Our results that sacubitril/valsartan independently improved RV function seem to be consistent with those of other small-scale studies. 20,21 Our findings suggest that the inhibitory effects of sacubitril/valsartan on the neprilysin and renin–angiotensin–aldosterone system activity might directly improve RV function, not just by compensatory effects through improvements in the LV pulmonary circulation. Clements et al 24 observed that RV function indicators significantly improved in a rat model of pulmonary hypertension after 6 weeks of sacubitril/valsartan treatment.…”

Section: Discussionmentioning

confidence: 78%

“…Some real-world studies have reported similar results regarding the benefits of sacubitril/valsartan on RV function. Masarone et al 20 demonstrated substantial TAPSE improvements after long-term sacubitril/valsartan treatment in patients with HFrEF during 1-year follow-up, and these improvements persisted after 2 years. In a previous observational cohort in Italy, the mean TAPSE significantly increased from 7.8 ± 3.9 mm at baseline to 16.5 ± 4.0 mm after 1-year treatment ( P < 0.001).…”

Section: Discussionmentioning

confidence: 97%

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

Yang

Shen

et al. 2021

Journal of Cardiovascular Pharmacology

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Objective: There is increasing evidence supporting the efficacy of sacubitril/valsartan for treating left heart failure, but few studies have investigated its effects on right ventricular (RV) dysfunction. This study aimed to explore the effects of sacubitril/valsartan on RV dysfunction among patients with heart failure with reduced ejection fraction (HFrEF). Methods: A total of 93 patients with HFrEF with RV dysfunction who were hospitalized from January 2018 through June 2019 were included in this retrospective observational study. All patients received their first sacubitril/valsartan treatment as in patients during the study period. We excluded 11 patients who were lost to follow-up or had incomplete heart echocardiography data. After 6 months of follow-up, we re-evaluated New York Heart Association Functional Classification and performed echocardiography to identify changes in relevant variables after treatment. Results: At baseline, 24% of the patients had an initial sacubitril/valsartan regimen of 12/13 mg twice daily and 76% of the patients had an initial dose of 24/26 mg twice daily. During follow-up, 27% of patients increased their dosage to 49/50 mg twice daily, 68% of patients were taking 24/26 mg twice daily, and 5% of the patients were still taking 12/13 mg twice daily. We found that sacubitril/valsartan treatment was associated with significant improvements in the following RV function indicators: tricuspid annular plane systolic excursion, tricuspid annular s′ peak velocity (S′), RV fractional area change, and pulmonary artery systolic pressure (PASP). Crude linear regression analysis revealed that a tricuspid annular plane systolic excursion improvement was positively correlated with a change in left ventricular ejection fraction (LVEF) and negatively correlated with a change in left ventricular end-systolic volume (LVESV). However, these correlations were nonexistent after adjusting for multiple echocardiographic variables. Conclusions: In patients with RV dysfunction and HFrEF, sacubitril/valsartan may improve RV remodeling. This influence may be independent of left cardiac remodeling.

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“…The gold standard for determining RV-PA coupling consists of the ratio between RV end-systolic elastance and effective arterial elastance [Ees/Ea] [ 17 , 26 ], which requires invasive measurements by means of a RHC as well as specific, dedicated material and is thus, rarely employed in clinical practice. Recently, the TAPSE/PASP ratio has been proposed as a non-invasive indicator of RV to PA coupling [ 19 , 20 , 21 , 22 , 27 ]. This index provides a valuable non-invasive measure of RV contractile state and RV load adaptability beyond the information afforded by each separate variable as an index of changes in RV length (TAPSE) versus developed force (PASP) [ 19 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Role of TAPSE to PASP Ratio in Patients Undergoing MitraClip Procedure

Trejo-Velasco

Estévez‐Loureiro

Carrasco-Chinchilla

et al. 2021

JCM

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Background: Transcatheter mitral valve repair (TMVR) is an effective therapy for high-risk patients with severe mitral regurgitation (MR) but heart failure (HF) readmissions and death remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in HF. In this study, we aimed to assess the prognostic value of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) ratio as a non-invasive measure of RV-to-PA coupling in patients undergoing TMVR with MitraClip (Abbott, CA, USA). Methods: Multicentre registry including 228 consecutive patients that underwent successful TMVR with MitraClip. The sample was divided in two groups according to TAPSE/PASP median value: 0.35. The primary combined endpoint encompassed HF readmissions and all-cause mortality. Results: Mean age was 72.5 ± 11.5 years and 154 (67.5%) patients were male. HF readmissions and all-cause mortality were more frequent in patients with TAPSE/PASP ≤ 0.35: Log-Rank 8.844, p = 0.003. On Cox regression, TAPSE/PASP emerged as a prognostic predictor of the primary combined endpoint, together with STS-Score. TAPSE/PASP was a better prognostic predictor than either TAPSE or PASP separately. Conclusions: TAPSE/PASP ratio appears as a novel prognostic predictor in patients undergoing MitraClip implantation that might improve risk stratification and candidate selection.

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Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Cited by 20 publications

References 40 publications

Sacubitril‐valsartan initiation in chronic heart failure patients impacts sleep apnea: the ENTRESTO‐SAS study

Sacubitril‐valsartan initiation in chronic heart failure patients impacts sleep apnea: the ENTRESTO‐SAS study

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

Prognostic Role of TAPSE to PASP Ratio in Patients Undergoing MitraClip Procedure

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