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Sacubitril-valsartan and its effect on ventricular remodeling
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)
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
,
Topic(s): Chronic Heart Failure: Pharmacotherapy
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.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.