Haemodynamic effects of sacubitril/valsartan in advanced heart failure
Piero Gentile1, Rosaria Cantone1, Enrico Perna1
1De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy.
Insights
Sacubitril/valsartan significantly reduced pulmonary and filling pressures in advanced heart failure patients. This angiotensin receptor-neprilysin inhibitor (ARNI) demonstrated safety and tolerability in this complex patient group.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Limited data exist on angiotensin receptor-neprilysin inhibitor (ARNI) efficacy in advanced heart failure (HF).
- ARNI, specifically sacubitril/valsartan, is approved for HF treatment.
Purpose of the Study:
- To assess the effects of ARNI treatment in patients with advanced heart failure.
- To evaluate changes in hemodynamic parameters and clinical outcomes following ARNI initiation.
Main Methods:
- Retrospective observational study of 44 advanced HF patients initiated on ARNI therapy.
- Hemodynamic assessments were performed before ARNI initiation and at 6 ± 2 months.
- Primary endpoint: variation in pulmonary and filling pressures.
Main Results:
- Significant reductions observed in systolic pulmonary artery pressure (P < 0.0001) and mean pulmonary artery pressure (P = 0.046) at 6 months.
- 23% of patients were deferred from heart transplant list due to improvement.
- No adverse events reported during follow-up.
Conclusions:
- Sacubitril/valsartan effectively reduces pulmonary and filling pressures in advanced HF.
- ARNI therapy is safe and well-tolerated in this patient population.
- Potential to improve outcomes and reduce need for advanced therapies like transplantation.
Aims:
The angiotensin receptor-neprilysin inhibitor (ARNI), sacubitril/valsartan, has been shown to be effective in treatment of patients with heart failure (HF), but limited data are available in patients with advanced disease. This retrospective observational study assessed the effects of ARNI treatment in patients with advanced HF.
Methods And Results:
We reviewed medical records of all advanced HF patients evaluated at our centre for unconventional therapies from September 2016 to January 2019. We studied 44 patients who started ARNI therapy and who had a haemodynamic assessment before beginning ARNI and after 6 ± 2 months. The primary endpoint was variation in pulmonary pressures and filling pressures at 6 months after starting ARNI therapy. Mean patient age was 51.6 ± 7.4 years; 84% were male. At 6 ± 2 months after starting ARNI, there was significant reduction of systolic pulmonary artery pressure [32 mmHg, interquartile range (IQR) 27-45 vs. 25 mmHg, IQR 22.3-36.5; P < 0.0001] and mean pulmonary artery pressure (20 mmHg, IQR 15.3-29.8 vs. 17 mmHg, IQR 13-24.8; P = 0.046). Five of 22 patients (23%) were deferred from the heart transplant list because of improvement, whereas four were listed de novo. After 23 ± 9 months, three patients were treated with a left ventricular assist device implantation, whereas six patients underwent heart transplantation (one in emergency conditions for refractory ventricular tachycardia).
Conclusions:
Sacubitril/valsartan is effective in reducing filling pressures and pulmonary pressures in patients with advanced HF. The absence of adverse events during follow-up suggests that sacubitril/valsartan is safe and well-tolerated in this cohort of patients.
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