Do the remodeling effects of sacubitril/valsartan treatment depend upon heart failure duration?
Alessandra Villani1, Silvia Ravaro1,2, Paolo Cerea1,2
1Istituto Auxologico Italiano IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, Metaboliche, Ospedale S. Luca.
Insights
Sacubitril/valsartan improved cardiac remodeling in heart failure patients. Early treatment, especially with shorter disease duration, showed significant benefits in left ventricular function and pulmonary circulation.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Sacubitril/valsartan is recommended for heart failure (NYHA class II-III, LVEF ≤35%).
- Cardiac remodeling is a key factor in heart failure progression.
- The impact of heart failure duration on treatment response requires further investigation.
Purpose of the Study:
- To evaluate the effects of sacubitril/valsartan on cardiac remodeling.
- To assess the correlation between heart failure duration and treatment outcomes.
- To analyze changes in clinical and echocardiographic parameters.
Main Methods:
- Retrospective analysis of 69 heart failure patients treated with sacubitril/valsartan.
- Data collection at baseline, 6 months, and 12 months.
- Echocardiographic, clinical, and laboratory data were analyzed.
Main Results:
- Significant improvements observed in NYHA class, NT-proBNP, LVEF, LV end-systolic volume, and pulmonary pressure.
- Patients with shorter disease duration (<8.5 years) showed greater improvement, including right ventricular function recovery.
- Patients with longer duration (≥8.5 years) had less pronounced improvements in LVEF and mitral regurgitation.
Conclusions:
- Sacubitril/valsartan effectively improves cardiac remodeling and pulmonary circulation.
- Shorter heart failure duration is associated with a more favorable response to sacubitril/valsartan.
- Early intervention with sacubitril/valsartan may lead to better long-term outcomes.
Aims:
The angiotensin receptor and neprilysin inhibitor (ARNI) sacubitril/valsartan (LCZ696) is recommended for the treatment of patients with heart failure in New York Heart Association (NYHA) class II-III and left ventricular ejection fraction (LVEF) 35% or less. We examined the effects of sacubitril/valsartan on cardiac remodeling and their correlation with heart failure duration in patients enrolled in our heart failure clinic from March 2017 to December 2019.
Methods:
Echocardiographic and clinical/laboratory data were collected at baseline and at 6-month and 12-month follow-up visits in 69 patients (age 67 ± 12 years, disease duration 8.4 ± 5.8 years, 93% men).
Results:
At both time points, mean NYHA class, NT-proBNP level, LVEF, LV end-systolic volume, and estimated systolic pulmonary pressure significantly (P < 0.05) improved versus baseline, as did the proportion of patients with diastolic dysfunction grade 3 or functional mitral regurgitation grade 3-4. In the subgroup with mean disease duration less than 8.5 years (n = 40), there was a significant improvement in all variables at both time points; in this group, a recovery of right ventricular function was also seen at the 12-month follow-up. On the contrary, patients with heart failure duration of at least 8.5 years (n = 29) showed only a slight improvement in LVEF and mitral regurgitation at 12 months. There were no significant changes in renal function and/or potassium levels in all patients.
Conclusion:
In patients with a relatively short disease duration, sacubitril/valsartan was associated with a strong favorable remodeling of the left ventricle and improvement in pulmonary circulation.
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