Hemodynamic Effects of Sacubitril/Valsartan in Patients with Reduced Left Ventricular Ejection Fraction Over 24 Months: A Retrospective Study

Abstract

Background The effects of sacubitril/valsartan in patients with chronic heart failure with reduced ejection fraction (HFrEF) were recently reported. However, the hemodynamic impact of this well-established treatment in patients with HFrEF has been poorly systematically researched. Aim We aimed to investigate the hemodynamic effects of sacubitril/valsartan among patients with HFrEF. Methods Between 2016 and 2020, we retrospectively collected data for patients with HFrEF treated at the University Medical Center Mannheim, Germany. Data for 240 patients with HFrEF were available. We systematically analyzed echocardiographic parameters, all-cause hospitalization, and congestion rate. Results The left ventricular ejection fraction (LVEF) improved from a median (minimum; maximum) of 28% (3; 65) before initiation of sacubitril/valsartan to a median of 34% (13; 64) at 24-month follow-up ( p < 0.001). Systolic pulmonary atrial pressure (PAPsys) decreased from a median of 30 mmHg (13; 115) to 25 mmHg (20; 80) at 24-month follow-up ( p = 0.005). The median (minimum; maximum) tricuspid annular plane systolic excursion improved from 17 mm (3; 31) at baseline to 20 mm (9; 30) at 12-month follow-up ( p = 0.007). The incidence of severe and moderate mitral, tricuspid, and aortic valvular insufficiency improved after treatment. Hospitalization and congestion rates reduced at 24-month follow-up. The mortality rate in echocardiographic and functional nonresponders was higher than in responders (12.1 vs. 5.2%; p = 0.1 and 11.3 vs. 3.1%; p = 0.01, respectively). Conclusion Follow-up 24 months after starting treatment with sacubitril/valsartan revealed sustained improvements in echocardiographic parameters, including LVEF, PAPsys, and cardiac valvular insufficiency. Rates of all-cause hospitalization and congestion had decreased significantly at follow-up. The mortality rate was higher in echocardiographic and functional nonresponders. Supplementary Information The online version contains supplementary material available at 10.1007/s40256-022-00525-w.

The impact of sacubitril/valsartan on outcome in patients suffering from heart failure with a concomitant diabetes mellitus

“…The effects were more observed in DM patients compared with patients with euglycaemic without insulin resistance or euglycaemic with insulin resistance 39 . Recently published data showed that sacubitril/valsartan reduced systolic pulmonary atrial pressure (PAPsys) from 30 to 25 mmHg over follow‐up 40 . However, our present study did not show changes of right ventricular echocardiography parameters in DM patients compared with no DM patients.…”

“… 39 Recently published data showed that sacubitril/valsartan reduced systolic pulmonary atrial pressure (PAPsys) from 30 to 25 mmHg over follow‐up. 40 However, our present study did not show changes of right ventricular echocardiography parameters in DM patients compared with no DM patients.…”

Effects of sacubitril/valsartan on life quality in chronic heart failure: A systematic review and meta-analysis of randomized controlled trials

“…As a result of its antifibrotic and antihypertrophic effect, sacubitril/valsartan also has reversal effects on cardiac remodeling in patients with HFrEF ( 11 ). At the level of hemodynamics, sacubitril/valsartan can induce the continuous improvement of left ventricular ejection fraction, tricuspid annular plane systolic excursion, and systolic pulmonary atrial pressure, with a reduction in the incidence of cardiac valvular insufficiency ( 12 ). In addition, the drug can provide additional renal benefits for patients with HF.…”

Effect of sacubitril/valsartan on the occurrence of cardiac arrhythmias and the risk of sudden cardiac death in heart failure: A meta-analysis of randomized controlled trials

“…In the PARADIGM-HF study, the further reduction of cardiovascular mortality, including SCD, observed in HFrEF received sacubitril/valsartan is likely due to a combined protective effect against death from HF and fatal ventricular arrhythmias ( 6 , 23 , 24 ). A retrospective study demonstrated sacubitril/valsartan therapy was associated with improvements in echocardiographic parameters, including LVEF, pulmonary atrial pressure and cardiac valvular insufficiency, in patients with HFrEF ( 25 ). To date, increasing evidence suggests that sacubitril/valsartan may have anti-arrhythmic properties, either by limiting pro-arrhythmic remodeling or through direct anti-arrhythmic effects on cardiomyocytes ( Figure 6 ) ( 5 , 26 – 28 ).…”