Effect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Patients With Heart Failure and Reduced Ejection...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Sacubitril-valsartan is known to reduce cardiovascular mortality and heart failure hospitalizations in patients with heart failure and reduced ejection fraction (HFrEF).
• The mechanisms underlying these benefits may involve effects on hemodynamics and cardiac remodeling.

Purpose of the Study:

• To investigate the impact of sacubitril-valsartan versus enalapril on central aortic stiffness and cardiac remodeling in patients with HFrEF.
• To compare changes in aortic characteristic impedance (Zc) and other cardiac remodeling markers between the two treatment groups.

Main Methods:

• A randomized, double-blind clinical trial involving 464 participants with HFrEF (ejection fraction ≤40%).
• Participants were randomized to receive either sacubitril-valsartan or enalapril for 12 weeks.
• The primary outcome was the change in central aortic stiffness (Zc); secondary outcomes included changes in N-terminal pro-B-type natriuretic peptide, ejection fraction, and various measures of cardiac remodeling.

Main Results:

• Sacubitril-valsartan did not significantly alter central aortic stiffness (Zc) compared to enalapril (treatment difference: -2.2 dyne × s/cm5; P=0.78).
• No significant difference was observed in the change of left ventricular ejection fraction between the groups.
• However, sacubitril-valsartan demonstrated significantly greater reductions in left atrial volume (P<.001), left ventricular end-diastolic volume index (P=.02), left ventricular end-systolic volume index (P=.045), and mitral E/e' ratio (P=.001) compared to enalapril.

Conclusions:

• Treatment with sacubitril-valsartan did not significantly reduce central aortic stiffness in patients with HFrEF when compared to enalapril.
• The observed improvements in left atrial volume and ventricular remodeling suggest potential mechanisms for sacubitril-valsartan's benefits in HFrEF.
• Further research may elucidate the comprehensive impact of sacubitril-valsartan on cardiovascular outcomes.