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

Abstract

Background Guidelines classify sacubitril/valsartan as a significant part of medical treatment of heart failure with reduced ejection fraction (HFrEF). Data have shown that the HbA1c levels in patients with diabetes mellitus could be impacted by sacubitril/valsartan. A possible positive effect in diabetes patients treated with sacubitril/valsartan on outcome and echocardiography parameters is not well studied yet. Aims The aim of the present study was to compare the impact of sacubitril/valsartan on life‐threatening arrhythmias, atrial fibrillation, different echocardiography parameters and congestion rate in patients suffering from HFrEF according to the diagnosis diabetes mellitus or no diabetes mellitus. Methods and results Consecutive 240 patients with HFrEF from 2016 to 2020 were treated with sacubitril/valsartan and separated to concomitant diabetes mellitus ( n = 87, median age 68 years interquartile range (IQR) [32–87]) or no diabetes mellitus ( n = 153, median age 66 year IQR [34–89]). Different comorbidities and outcome data were evaluated over a follow‐up period of 24 months. Arterial hypertension (87% vs. 64%; P < 0.01) and coronary artery disease (74% vs. 60%; P = 0.03) were more often documented in patients with diabetes mellitus compared with patients without diabetes mellitus. Over the follow‐up of 24 months several changes were noted in both subgroups: Median left ventricular ejection fraction (EF) increased significantly in non‐diabetes (27% IQR [3–44] at baseline to 35% IQR [13–64]; P < 0.001), but not in diabetic patients (29% IQR [10–65] at baseline to 30% IQR [13–55]; P = 0.11). Accordingly, NT‐proBNP and troponin‐I levels decreased significantly in non‐diabetes patients (NT‐brain natriuretic peptide [NT‐proBNP] from median 1445 pg/mL IQR [12.6–74 676] to 491 pg/mL IQR [13–4571]; P < 0.001, troponin‐I levels from 0.099 ng/mL IQR [0.009–138.69] to 0.023 ng/mL IQR [0.006–0.635]; P < 0.001), but not in diabetic patients (NT‐proBNP from 1395 pg/mL IQR [100–29 924] to 885 pg/mL IQR [159–4331]; P = 0.06, troponin‐I levels from 0.05 ng/mL IQR [0.013–103.0] to 0.020 ng/mL IQR [0.015–0.514]; P = 0.27). No significant change of laboratory parameters e. g. glomerular filtration rate, potassium level and creatinine levels were found in diabetes or non‐diabetes patients. Comparing further echocardiography data, left atrial surface area, right atrial surface area, E/A ratio did not show a significant change either in the diabetes or non‐diabetes group. However, the tricuspid annular plane systolic excursion was significantly increased in non‐diabetes mellitus patients (from 17 mm IQR [3–31] to 18 mm [2.5–31]; P = 0.04)...

Association of D-dimer to albumin ratio with adverse cardiovascular outcomes in ischaemic heart failure patients with diabetes mellitus: a retrospective cohort study

“…These findings were consistent with previous studies47–49 and might cause the predication deviation in the subgroup of the diffuse lesion and CTO lesion in the stratified analysis. Furthermore, some medications used lowered the incidence of MACE, such as sacubitril/valsartan was the most vital protective factor and lowered 37% the risk of MACE, which was compatible with the previous study in the HF and DM cohort 50. DAR remained an independent predictor in the multivariable Cox regression model after adjusting these confounders.…”

“…Furthermore, some medications used lowered the incidence of MACE, such as sacubitril/valsartan was the most vital protective factor and lowered 37% the risk of MACE, which was compatible with the previous study in the HF and DM cohort. 50 DAR remained an independent predictor in the multivariable Cox regression model after adjusting these confounders.…”

Sacubitril/Valsartan Improves Left Atrial and Ventricular Strain and Strain Rate in Patients with Heart Failure with Reduced Ejection Fraction

“…Previous observational and retrospective studies have demonstrated that sacubitril/valsartan induces early reverse remodeling in HFrEF patients, with a significant reduction in left ventricular (LV) dimensions, improvement in LV ejection fraction (LVEF)-both Life 2023, 13, 995 2 of 16 in patients with nonischemic and ischemic HFrEF-and improvement in diastolic function, systolic pulmonary artery pressure, mitral and tricuspid valve insufficiency [7][8][9][10]. LV reverse remodeling with sacubitril/valsartan therapy was described in HFrEF patients without diabetes versus diabetic patients [11]. However, sacubitril/valsartan was not associated with a reduced risk of ventricular tachyarrhythmias in chronic HFrEF patients [12].…”

Validation of the Portuguese Version of the Kansas City Cardiomyopathy Questionnaire-12

“…On the other hand, increments ≥ 5 units in KCCQ-12 determine risk reduction of composite hospitalization and all-cause mortality in patients with reduced LVEF [HR: 0.73 (CI: 0.59-0.89)] [13]. In this context, co-morbidities, such as diabetes, may increase risk severity of HF and mortality [23], as well as drugs treatment optimization may impact on health status. For instance, clinical trials showed that sacubitril/valsartan are effective to improve health status using KCCQ [24] and to reduce mortality in patients with reduced LVEF [25].…”