Sacubitril/valsartan versus enalapril on exercise capacity in patients with heart failure with reduced ejection fraction: A randomized, double-blind, active-controlled study

Santos, Marcelo Rodrigues dos; Alves, Maria-Janieire de Nazaré Nunes; Jordão, Camila Paixão; Pinto, Caio Eduardo Novaes; Correa, Kelly Thayane Souza; Souza, Francis Ribeiro de; Fonseca, Guilherme Wesley Peixoto da; Filho, Joaquim Tomaz; Costa, Maria da Piedade Resende da; Pereira, Rosa Maria Rodrigues; Negräo, Carlos Eduardo; Barretto, Antônio Carlos Pereira

doi:10.1016/j.ahj.2021.05.005

Cited by 20 publications

(30 citation statements)

References 32 publications

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“…Patients in this study had a mean baseline peak VO 2 of 12.9 mL/min/kg in the sacubitril/valsartan and 13.7 mL/min/kg in the enalapril group and thus were already very limited in their exercise capacity, making them potentially more refractory to treatment than less symptomatic patients. However, a recently published study did not show significant differences in peak VO 2 between sacubitril/valsartan and enalapril even in patients with a mean peak VO 2 of 19 mL/min/kg 23 . In our study, after 12 weeks, patients randomized to sacubitril/valsartan had a significantly lower energy consumption and higher inactivity time (supine lying time).…”

Section: Discussioncontrasting

confidence: 70%

“…Similarly, we did not observe a significant difference between the two treatment groups in other CPET parameters and QoL such as workload (W) at VT1, change of VO 2 at VT1, and KCCQ, except for a reduction in heart rate at VT1 with sacubitril/valsartan at Week 12. Similarly, in a recent single‐centre, randomized study, treatment with sacubitril/valsartan was not associated with improvements in exercise capacity, including peak VO 2 and 6MWT 23 . Despite several differences between the two studies, these observations suggest that, although sacubitril/valsartan is superior when compared with enalapril in reducing mortality and morbidity, 3 it may have limited impact on improving exercise capacity in patients with HFrEF and NYHA class III within the first 3 months of treatment.…”

Section: Discussionmentioning

confidence: 89%

“…Similarly, in a recent single-centre, randomized study, treatment with sacubitril/valsartan was not associated with improvements in exercise capacity, including peak VO 2 and 6MWT. 23 Despite several differences between the two studies, these observations suggest that, although sacubitril/valsartan is superior when compared with enalapril in reducing mortality and morbidity, 3 it may have limited impact on improving exercise capacity in patients with HFrEF and NYHA class III within the first 3 months of treatment.…”

Section: Discussionmentioning

confidence: 99%

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A randomized clinical trial on the short‐term effects of 12‐week sacubitril/valsartan vs. enalapril on peak oxygen consumption in patients with heart failure with reduced ejection fraction: results from the ACTIVITY‐HF study

Halle

Schöbel

Winzer

et al. 2021

European J of Heart Fail

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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A randomized clinical trial on the short‐term effects of 12‐week sacubitril/valsartan vs. enalapril on peak oxygen consumption in patients with heart failure with reduced ejection fraction: results from the ACTIVITY‐HF study

Halle

Schöbel

Winzer

et al. 2021

European J of Heart Fail

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“…In OUTSTEP‐HF, 5 sacubitril/valsartan did not improve the 6‐min walk distance any more than enalapril. Dos Santos et al ., 6 on the contrary, found an increase in peak VO 2 and 6‐min walk distance with sacubitril/valsartan compared to enalapril at 12 and 24 weeks.…”

Section: How To Explain This a Priori Counter‐intuitive Results?mentioning

confidence: 86%

New treatments for heart failure and exercise capacity

Cohen‐Solal

Beauvais

2021

European J of Heart Fail

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This article refers to'A randomized clinical trial on the short-term effects of 12-week sacubitril/valsartan vs. enalapril on peak oxygen consumption in patients with heart failure with reduced ejection fraction: results from the ACTIVITY-HF study' by M. Halle et al., published in this issue on pages 2073-2082.New heart failure drugs have proven to be remarkably effective in recent years in improving prognosis (mortality and rehospitalizations) but also symptoms and quality of life of patients with heart failure. Improving quality of life and exercise capacity is now recognized as an important criterion by health authorities, in addition to improving prognosis, and is often requested for registration of a drug or a device in heart failure.Sacubitril/valsartan is one of these new drugs that markedly improves prognosis, symptoms and quality of life in patients. In this issue of the Journal, Halle et al. 1 evaluated if sacubitril/valsartan also improved, as one could imagine, maximal exercise capacity, measured by cardiorespiratory exercise testing, compared to enalapril, an angiotensin-converting enzyme inhibitor (ACEi). ACTIVITY-HF is the first randomized study to evaluate the effects of sacubitril/valsartan on maximal exercise capacity in New York Heart Association class III patients with heart failure with reduced ejection fraction (HFrEF).At the end of a well-conducted, randomized, double-blind, parallel-group study in 201 HFrEF patients, sacubitril/valsartan did not significantly improve maximal oxygen uptake (VO 2 ) after 3 months of treatment compared to enalapril. Absolute increase in mean peak VO 2 was very low (+0.5 and +0.1 ml/min/kg only in the sacubitril/valsartan and the valsartan group, respectively). The authors also found no benefit on submaximal exercise parameters [supposed to better reflect the ability to perform submaximal efforts during daily life, such as the minute ventilation to carbon dioxide production (VE/VCO 2 ) slope or the ventilatory threshold]. There was also no improvement in the 6-min walk test. Quality of life, assessed by questionnaires, daily physical activity assessed by actigraphy, were no more, apparently surprisingly, improved by sacubitril/valsartan compared to enalapril.

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“…A relevant question is whether these improvements had to be ascribed to the exercise training alone or whether other components of the rehabilitation intervention also concurred to the observed benefits. Theoretically, according to literature data showing an improvement in functional capacity and cardiopulmonary parameters in patients with HF (Giallauria et al, 2020;Malfatto et al, 2020;Dos Santos et al, 2021), we cannot dismiss the possibility that the optimization of pharmacological treatment might also have played a role. However, we have to underscore that, in our study, changes in therapy concerned a very limited number of patients over a limited number of days.…”

Section: Discussionmentioning

confidence: 95%

The Impact of Cardiac Rehabilitation on Activities of Daily Life in Elderly Patients With Heart Failure

et al. 2022

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Background: In elderly chronic heart failure (HF) patients, activities of daily living (ADLs) require the use of a high proportion of patients’ peak aerobic capacity, heart rate, and ventilation.Objectives: To assess the effects of short-term comprehensive cardiac rehabilitation (CR) on the metabolic requirement of ADLs in elderly patients with chronic HF.Methods: The study population comprised 99 elderly chronic HF patients (mean age 72 ± 5 years, 80% male, 61% ejection fraction <40%, mean NT-proBNP 2,559 ± 4,511 pg/ml) participating in a short-term (mean days 19 ± 7) residential CR program. Before and after CR, participants, while wearing a portable ergospirometer, performed a standardized ADL battery: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 min), ADL6 (climbing 1 flight of stairs carrying a 1.5 Kg load), and ADL7 (a standard 6-min walking test).Results: After CR, task-related oxygen uptake did not change in any of the domestic ADLs. Notably, there was a significant decrease in the cumulative time required to perform ADLs (ADL 1–4 and ADL6; from 412 ± 147 to 388 ± 141 s, p = 0.001) and a reduction in maximal heart rate in ADL1 and 3 (p = 0.005 and p = 0.027, respectively). Changes occurred in the 6MWT with an increase in oxygen uptake (p = 0.005) and in the distance covered (p < 0.001) and a significant decrease in the Borg scale of dyspnea (p = 0.004).Conclusion: Elderly patients with chronic heart failure who are engaged in a short-term residential CR program improve the performance of routine ADLs.

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Sacubitril/valsartan versus enalapril on exercise capacity in patients with heart failure with reduced ejection fraction: A randomized, double-blind, active-controlled study

Cited by 20 publications

References 32 publications

A randomized clinical trial on the short‐term effects of 12‐week sacubitril/valsartan vs. enalapril on peak oxygen consumption in patients with heart failure with reduced ejection fraction: results from the ACTIVITY‐HF study

A randomized clinical trial on the short‐term effects of 12‐week sacubitril/valsartan vs. enalapril on peak oxygen consumption in patients with heart failure with reduced ejection fraction: results from the ACTIVITY‐HF study

New treatments for heart failure and exercise capacity

The Impact of Cardiac Rehabilitation on Activities of Daily Life in Elderly Patients With Heart Failure

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