Effects of Sacubitril/Valsartan on the Renal Resistance Index

Abstract

Background: Sacubitril/valsartan plays a key role in improving left ventricular remodeling and prognosis in patients with heart failure with a reduced ejection fraction (HFrEF). Moreover, some data support its role in preserving renal function. In order to better clarify the effects of sacubitril/valsartan in cardiorenal syndrome, this study evaluated its effects on the renal resistance index (RRI). Methods: A group of patients with HFrEF was enrolled. The RRI was assessed with renal echo-color Doppler at enrollment and again after at least six months of sacubitril/valsartan treatment. In a subgroup of patients, the RRI was also evaluated at least six months before enrollment. The variations in echocardiographic parameters reflecting the left and right ventricular function, as well as creatinine and the estimated glomerular filtration rate, were also evaluated. Results: After treatment with sacubitril/valsartan, significant improvements in the left ventricular ejection fraction, and a decrease in the left atrial and ventricular volumes were observed. The RRI also showed a significant decrease. No relationship was found between the improvements in the parameters reflecting cardiac function and changes in the RRI. Conclusions: Treatment with sacubitril/valsartan is associated with improvements in both left ventricular function and renal perfusion, through decreasing the renal resistance. These data help to clarify the effects of the drug on cardiorenal syndrome progression.

Renal Arterial and Venous Doppler in Cardiorenal Syndrome: Pathophysiological and Clinical Insights

“…Moreover, the RRI may help identify CHF patients who are susceptible to worse renal outcomes, such as those at risk of developing diuretic resistance (defined by the necessity for higher diuretic doses) and WRF, throughout mid-to-long-term follow-up [ 44 , 45 ]. On the other hand, treatments able to improve the cardiac function, such as sacubitril/valsartan, could also induce an improvement in the RRI [ 46 ]. These data emphasize the valuable role of the RRI in evaluating the renal hemodynamic status and forecasting the risk of heart failure progression, renal decline, and adverse events in patients affected by heart failure.…”

Current Insights into Renal Resistive Index Significance in Kidney and Cardiovascular Disease

“…In heart failure (HF) patients, regardless of LVEF, RRI is an important marker of renal dysfunction and cardiovascular outcome [117]. Thus, high RRI correlates with reactive oxidative species, endothelial dysfunction and increased inflammatory cytokine secretion [118]. Moreover, RRI is influenced by neuro-hormonal activity, which is augmented in HF and depends on the central venous pressure, which is also increased in HF patients [118].…”

“…The new ESC guideline for acute and chronic HF updated the medical treatment with two new classes of drugs: sacubitril/valsartan and sodium/glucose transport protein 2 (SGLT2) inhibitors [123]. The benefit of sacubitril/valsartan in HF patients with reduced LVEF is mediated not only by cardiac protection (natriuretic and diuretic effects, increased EF, reverse remodeling, improved diastolic function) but also by favourable renal effects, implying an improvement of cardiorenal syndrome [118]. Thereby, in the kidney, due to inhibition of angiotensin II receptors and neprylisin, sacubitril/valsartan favors natriuresis and diuresis, dilatation of afferent arteriole with improved GFR and arterial renal flow, decreasing RRI [118].…”

“…The benefit of sacubitril/valsartan in HF patients with reduced LVEF is mediated not only by cardiac protection (natriuretic and diuretic effects, increased EF, reverse remodeling, improved diastolic function) but also by favourable renal effects, implying an improvement of cardiorenal syndrome [118]. Thereby, in the kidney, due to inhibition of angiotensin II receptors and neprylisin, sacubitril/valsartan favors natriuresis and diuresis, dilatation of afferent arteriole with improved GFR and arterial renal flow, decreasing RRI [118]. In addition, sacubitril/valsartan reduces renal fibrosis by neprylisin inhibition, an enzyme that causes efferent arteriole dilatation, glomerular hypertrophy and increased mesangial tissue [118].…”

“…Thereby, in the kidney, due to inhibition of angiotensin II receptors and neprylisin, sacubitril/valsartan favors natriuresis and diuresis, dilatation of afferent arteriole with improved GFR and arterial renal flow, decreasing RRI [118]. In addition, sacubitril/valsartan reduces renal fibrosis by neprylisin inhibition, an enzyme that causes efferent arteriole dilatation, glomerular hypertrophy and increased mesangial tissue [118].…”