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Changes in hemodynamic profile in patients with severe systolic dysfunction treated with sacubitril-valsartan

Session Poster Session 3

Speaker Francesca Corazza

Event : Heart Failure 2019

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

Authors : F Corazza (Bologna,IT), A Ceccarelli (Bologna,IT), G Vitale (Bologna,IT), S Boschi (Bologna,IT), L Giovannini (Bologna,IT), M Masetti (Bologna,IT), A Russo (Bologna,IT), L Potena (Bologna,IT)

Authors:
F Corazza1 , A Ceccarelli1 , G Vitale1 , S Boschi1 , L Giovannini1 , M Masetti1 , A Russo1 , L Potena1 , 1Bologna University Hospital - Bologna - Italy ,

Citation:

Background. Post-capillary pulmonary hypertension (PC-PH) is a frequent complication and prognostic marker in patients with advanced heart failure (HF). No specific treatments are available for PC-PH other than optimal HF therapy. In this context, we tested the hypothesis that therapy optimization with sacubitril-valsartan (LCZ), known to reduce the risk of death and hospitalizations for HF, could improve the hemodynamic profile of patients with HF and PC-PH.

Methods. Among the patients included in our institutional prospective HF Registry, we included in this analysis those who underwent two right heart catheterizations (RHC) and started LCZ in between, in the period July 2017 to December 2018. All patients were evaluated for heart transplantation and RHC is part of our routine clinical practice as follow-up strategy in these patients. Baseline and follow-up RHC were compared by paired T-test. Changes in guideline directed therapy (GDT) were also assessed.

Results. 35 patients (86% males; aged 53.3 ± 8.4y, 10(29%) with ischemic etiology, and 12 (34%) in NYHA class III-IV) with severe left ventricular dysfunction (ejection fraction: 25.6±7.5%) underwent two RHC at 187±85 days interval. All patients were receiving therapy with diuretics (187±85mg/day), ACE-i/ARBs (43±27% of GDT dose), and beta-blockers (57±33% of GDT dose) at the time of baseline RHC. LCZ was started at a median of 21(0-116) days after the baseline RHC. By comparing baseline with follow-up RHC in a matched paired fashion, we observed significant reduction of mean pulmonary artery pressure (from 31±11 to 26±9 mmHg; P<0.01), pulmonary capillary wedge pressure (from 21±7 to 18±8 mmHg; P<0.01) and pulmonary vascular resistances (from 2.8±1.7 to 2.0±1.0 WU; P<0.01), associated with a significant increased of cardiac index (from 2.1±0.4 to 2.3±0.6 l/min/m2; P=0.03). Conversely, systolic systemic pressure did not change significantly (from 110±12 to 107±12 mmHg; P=0.16). Of note, diuretics and beta-blockers dose did not change significantly between the two RHC.

Conclusions. In the context of stable and optimized at the maximal tolerated dose of GDT, this pilot experience suggests that LCZ may improve the management of PC-PH in patients with severe LV dysfunction. The changes in hemodynamic profile, including the increase in cardiac index, provide a pathophysiological background of the clinical benefits observed in the LCZ randomized trial.

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