Long-Term Effects of Sacubitril-Valsartan on Cardiac Remodeling: A Parallel Echocardiographic Study of Left and Right Heart Adaptive Response

Abstract

Sacubitril/Valsartan (S/V) carries potential anti-remodeling properties, however long-term effects and biventricular adaptive response are poorly described. 76 HFrEF patients who underwent progressive uptitration of S/V, completed the annual scheduled follow-up. After a median follow-up of 11 (8–13) months, left ventricular (LV) reverse remodeling (RR) is defined as (1) absolute increase in LV ejection fraction (EF) ≥ 10% or LVEF ≥ 50% at follow-up and (2) decrease in indexed LV end-diastolic diameter (LVEDDi) of at least 10% or indexed LVEDDi ≤ 33 mm/m2, occurred in 27.6%. Non-ischemic etiology, shorter duration of HF, and absence of a history of AF were independently associated with LVRR (p < 0.05). TAPSE and TAPSE/PASP, a non-invasive index of right ventricular (RV) coupling to the pulmonary circulation, significantly improved at follow-up (0.45 vs. 0.56, p = 0.02). 41% of patients with baseline RV dysfunction obtained favorable RV remodeling despite only a moderate correlation between RV and LV function was observed (r = 0.478, p = 0.002). Our data point to a potential long-term reverse global remodeling effect by S/V, especially in patients who start S/V at an early stage of the disease, and focus our attention on a possible direct effect of the drug in synergistic hemodynamics between RV and pulmonary circulation.

Does sacubitril/valsartan work in children with heart failure?—a pilot study

“…In the past few years, several studies reported sacubitril/valsartan could ameliorate HF by reversing ventricular remodeling in animal models (14)(15)(16)(17), from which we can postulate that sacubitril/ valsartan might play a role in attenuating the process of ventricular remodeling in HF children. Moreover, it is reported that sacubitril/valsartan might attenuate right ventricular modeling and benefit patients with right heart overload or dysfunction (18)(19)(20)(21), which is also proved in animal models in the latest researches (22).…”

Right Ventricular Subclinical Dysfunction in SLE Patients Correlates with Metabolomic Fingerprint and Organ Damage

“…Moreover, both left and right ventricular dimensions and function modifications correlate with prognosis [ 29 , 30 ] and response to therapies [ 31 , 32 ].…”

The Rare Condition of Left Ventricular Non-Compaction and Reverse Remodeling

“…The etiology and duration of HF are factors that can influence outcome. The increase in LVEF is more important in patients with non-ischemic or new-onset HF (≤12 months) [ 103 , 104 ]. In an early and reversible stage of the disease, sacubitril/valsartan can prevent global cardiac remodeling, and this was sustained by the results of the PIONEER-HF trial (Comparison of Sacubitril/Valsartan Versus Enalapril on Effect on NT-proBNP in Patients Stabilized From an Acute Heart Failure Episode) [ 105 ].…”

“…Furthermore, an important decrease in NT-proBNP level is associated with greater improvements in the LVEF and a more important reduction of LV volumes [ 102 ]. Additionally, a younger age and a sinus rhythm identify a subgroup of patients with a more likely reverse LV remodeling [ 104 ]. All of these features that are associated with reverse remodeling were present in our patient.…”