Impact of Sacubitril-Valsartan Treatment on Diastolic Function in Patients with Heart Failure and Reduced Ejection Fraction.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Adis, Springer International Country of Publication: New Zealand NLM ID: 9421087 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1179-1985 (Electronic) Linking ISSN: 11209879 NLM ISO Abbreviation: High Blood Press Cardiovasc Prev Subsets: MEDLINE
    • Publication Information:
      Publication: Auckland : Adis, Springer International
      Original Publication: Milano : Editrice Kurtis s.r.l., c1992-
    • Subject Terms:
      Aminobutyrates/*therapeutic use ; Angiotensin II Type 1 Receptor Blockers/*therapeutic use ; Heart Failure/*drug therapy ; Neprilysin/*antagonists & inhibitors ; Protease Inhibitors/*therapeutic use ; Stroke Volume/*drug effects ; Tetrazoles/*therapeutic use ; Ventricular Function, Left/*drug effects; Aged ; Aminobutyrates/adverse effects ; Angiotensin II Type 1 Receptor Blockers/adverse effects ; Biphenyl Compounds ; Diastole ; Drug Combinations ; Echocardiography ; Female ; Heart Failure/diagnostic imaging ; Heart Failure/physiopathology ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Prospective Studies ; Protease Inhibitors/adverse effects ; Recovery of Function ; Tetrazoles/adverse effects ; Time Factors ; Treatment Outcome ; Valsartan
    • Abstract:
      Introduction: Sacubitril/valsartan (S-V) has been shown to reduce clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This benefit has been mostly attributed to an improvement in systolic function.
      Aim: This study aimed to evaluate longitudinal changes in several echocardiographic parameters of diastolic function in a cohort of patients with HFrEF receiving S-V.
      Methods: Echocardiographic parameters of consecutive patients receiving S-V, such as diastolic dysfunction (DD) grade and other individual diastolic and systolic function parameters, were prospectively collected at baseline and at 6-month follow-up. New York Heart Association (NYHA) functional class was also recorded.
      Results: 65 patients (73.9% males; 61.5 ± 13 years) with HFrEF in NYHA class II-IV were evaluated. There was a significant reduction in DD grade after treatment with maximal tolerated doses (p < 0.001). Patients with advanced DD showed the most significant improvements: 75% and 60% of patients with initial grade 3 and 2, respectively, had better grade after 6 months of S-V. Moreover, there was a reduction in E/e' ratio (p = 0.004), left atrial longitudinal strain (p = 0.002), and an improvement of left ventricle ejection fraction (p < 0.001) and NYHA functional class (p = 0.001). Among those subjects who improved their functional class, a higher percentage improved their DD grade (39.3%, p = 0.025) in comparison with those not improving their NYHA class (25%, p = 0.434).
      Conclusions: In addition to an improvement in systolic function parameters, patients with HFrEF receiving S-V improved their diastolic function. This echocardiographic improvement is particularly relevant in those patients with better NYHA class at 6-month follow-up.
    • Comments:
      Comment in: High Blood Press Cardiovasc Prev. 2021 Jul;28(4):331-332. (PMID: 33905096)
    • References:
      Tromp J, Ferreira JP, Janwanishstaporn S, Shah M, Greenberg B, Zannad F, Lam C. Heart failure around the world. Eur J Heart Fail. 2019;21:1187–96. (PMID: 10.1002/ejhf.1585)
      Pellicori P, Khan MJI, Graham FJ, Cleland JGF. New perspectives and future directions in the treatment of heart failure. Heart Fail Rev. 2020;25:147–59. (PMID: 10.1007/s10741-019-09829-7)
      Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med. 1996;334:1349–55. (PMID: 10.1056/NEJM199605233342101)
      The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316:1429–35. (PMID: 10.1056/NEJM198706043162301)
      Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341:709–17. (PMID: 10.1056/NEJM199909023411001)
      Rossello X, Ariti C, Pocock SJ, Joao PF, Girerd N, McMurray JJV, Van Veldhuisen DJ, Pitt B, Zannad F. Impact of mineralocorticoid receptor antagonist on the risk of sudden cardiac death in patients with heart failure ant left-ventricular systolic dysfunction: an individual patient-level meta-analysis of three randomized-controlled trials. Clin Res Cardiol. 2019;108:477–86. (PMID: 10.1007/s00392-018-1378-0)
      McMurray JJV, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al. Angiotensin–neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993–1004. (PMID: 10.1056/NEJMoa1409077)
      Consentino ER, Esposti DD, Miceli R, Bentivenga C, Landolfo M, Cicero AFG, Berardi E, Spinardi L, Magri G, Dugato V, Borghi C. Sacubitril/valsartan improves both functional and echocardiographic parameters in patients with chronic heart failure with reduced ejection fraction. Curr Med Res Opin. 2019;35:9–12. (PMID: 10.1080/03007995.2019.1576481)
      Moliner-Arbós C, Rivas-Lasarte M, Pamies Besora J, Fluvià-Brugues P, Solé-González E, Mirabet S, López López L, Brossa V, Pirla MJ, Mesado N, Álvarez-García J, Roig E. Sacubitril–Valsartan in real-life practice: experience in patients with advanced heart failure and systematic review. Cardiovasc Drugs Ther. 2019;33:307–14. (PMID: 10.1007/s10557-019-06858-0)
      Almufleh A, Marbach J, Chih S, Stadnick E, Davies R, Liu P, Mielniczuk L. Ejection fraction improvement and reverse remodeling achieved with sacubitril/valsartan in heart failure with reduced ejection fraction patients. Am J Cardiovasc Dis. 2017;7:108–13. (PMID: 293489715768868)
      Martens P, Beliën H, Dupont M, Vandervoort P, Mullens W. The reverse remodeling response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction. Cardiovasc Ther. 2018;36:e12435. (PMID: 10.1111/1755-5922.12435)
      Januzzi JL Jr, Prescott MF, Butler J, Felker GM, Maisel AS, McCague K, Camacho A, Piña IL, Rocha RA, Shah AM, Williamson KM, Solomon SD. Association of change in N-terminal Pro-B-type natriuretic peptide following initiation of sacubitril-valsartan treatment with cardiac structure and function in patients with heart failure with reduced ejection fraction. JAMA. 2019;322:1–11. (PMID: 10.1001/jama.2019.12821)
      Khan Z, Gholkar G, Tolia S, Kado H, Zughaib M. Effect of sacubitril/valsartan on cardiac filling pressures in patients with left ventricular systolic dysfunction. Int J Cardiol. 2018;271:169–73. (PMID: 10.1016/j.ijcard.2018.03.093)
      Ponikowski P, Voors A, Anker S, Bueno H, Cleland JGF, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129–200. (PMID: 10.1093/eurheartj/ehw128)
      Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137-161. (PMID: 10.1161/CIR.0000000000000509)
      Lang R, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1–39. (PMID: 10.1016/j.echo.2014.10.003)
      Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29:277–314. (PMID: 10.1016/j.echo.2016.01.011)
      Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM. LA strain categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging. 2017;10:735–43. (PMID: 10.1016/j.jcmg.2016.08.014)
      Kang DH, Park SJ, Shin SH, Hong GR, Lee S, Kim MS, Yun SC, Song JM, Park SW, Kim JJ. Angiotensin receptor neprilysin inhibitor for functional mitral regurgitation. Circulation. 2019;139:1354–65. (PMID: 10.1161/CIRCULATIONAHA.118.037077)
      Worley E, Rana B, Williams L, Robinson S. Left ventricular diastolic dysfunction: identifying presence by left atrial function. Echo Res Pract. 2018;5:97–104. (PMID: 10.1530/ERP-18-0013)
      Muiesan ML, Paini A, Agabiti Rosei C, Bertacchini F, Stassaldi D, Salvetti M. Current pharmacological therapies in heart failure patients. High Blood Press Cardiovasc Prev. 2017;24:107–14. (PMID: 10.1007/s40292-017-0194-3)
      Hubers SA, Brown NJ. Combined angiotensin receptor antagonism and neprilysin inhibition. Circulation. 2016;133:1115–24. (PMID: 10.1161/CIRCULATIONAHA.115.018622)
    • Contributed Indexing:
      Keywords: Diastolic function; Heart failure; Sacubitril–valsartan; Systolic function
    • Accession Number:
      0 (Aminobutyrates)
      0 (Angiotensin II Type 1 Receptor Blockers)
      0 (Biphenyl Compounds)
      0 (Drug Combinations)
      0 (Protease Inhibitors)
      0 (Tetrazoles)
      80M03YXJ7I (Valsartan)
      EC 3.4.24.11 (Neprilysin)
      WB8FT61183 (sacubitril and valsartan sodium hydrate drug combination)
    • Publication Date:
      Date Created: 20210218 Date Completed: 20210406 Latest Revision: 20211204
    • Publication Date:
      20221213
    • Accession Number:
      10.1007/s40292-021-00437-x
    • Accession Number:
      33599965