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Sacubitril-valsartan and its effect on ventricular remodeling

Session Poster Session 2

Speaker Susana Del Prado Diaz

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : M Abellas Sequeiros (Madrid,ES), S Del Prado (Madrid,ES), G Alonso Salinas (Madrid,ES), A Lorente Ros (Madrid,ES), JM Vieitez Florez (Madrid,ES), JL Moya Mur (Madrid,ES), A Garcia Martin (Madrid,ES), JJ Jimenez Nacher (Madrid,ES), C Fernandez Golfin (Madrid,ES), JL Zamorano Gomez (Madrid,ES)

Authors:
M Abellas Sequeiros1 , S Del Prado1 , G Alonso Salinas1 , A Lorente Ros1 , JM Vieitez Florez1 , JL Moya Mur1 , A Garcia Martin1 , JJ Jimenez Nacher1 , C Fernandez Golfin1 , JL Zamorano Gomez1 , 1University Hospital Ramon y Cajal de Madrid - Madrid - Spain ,

Citation:

Introduction:

Based on the PARADIGM HF trial, sacubitril-valsartan has been included in ESC guidelines for the treatment of chronic heart failure with reduced ejection fraction (HFrEF). Angiotensin receptor-neprilysin inhibitor has demonstrated to improve left ventricular ejection fraction (LVEF). Is LVEF the only parameter modified?

Methods:

To answer this question, a series of patients with HFrEF attending the advanced heart failure unit who initiated sacubitril-valsartan was prospectively assessed. Aetiology and baseline characteristics were collected. LVEF and ventricular volumes  were evaluated by transthoracic echocardiogram before and after 6 and 12-month treatment. T- test was conducted for the comparison of paired data.

Results:

Eighty-four patients initiated sacubitril-valsartan. Patients with drug discontinuation or without echocardiogram before and 6-12months after therapy were excluded. Seventy patients were evaluated. Mean age was 73 years old; 58 (83%) patients were men and 54% had ischaemic aethiology. 53% had atrial fibrillation and 54% were diabetic. Mean LVEF was 31,1% and median estimated glomerular filtration rate was 65,4 ml/min. Regarding to optimal medical treatment: 97% were on angiotensin-converting-enzyme inhibitor, 91% beta-blocker and 77% were receiving a mineralocorticoid-receptor antagonist.

Left ventricular ejection fraction significantly improved after 6-month treatment (31,1±4,8 vs 40,7±10,2; p<0,001). Lower left ventricular end systolic (109,2±41,4 vs 83,0±47,2; p=0,006) and end diastolic volumes (163,2±57,9 vs 136,5±57,1; p=0,021) were described. There is a tendency to support these observations also after 12 months: LVEF remained lower (p= 0,003), as well as left ventricular end systolic volume (p=0,058).

Conclusions:

Neprilysin inhibition has a beneficial effect on ventricular structure, improving not only ventricular volumes, but also ejection fraction. Longer follow-up periods need to be assess, as this improvement might change therapeutic approaches based on LVEF, for example, the indication of cardiac resynchronization therapy.

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