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Effect of sacubitril/valsartan on natriuretic peptide in patients with compensated heart failure
Akihiro Shirakabe1, Masato Matsushita2, Tomofumi Sawatani2
1Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. s6042@nms.ac.jp.
Insights
Sacubitril/valsartan (S/V) therapy significantly increased atrial natriuretic peptide (ANP) levels and reduced diuretic doses in Asian heart failure patients. This neprilysin inhibitor treatment showed promise for managing compensated heart failure, particularly in those with atrial fibrillation and preserved ejection fraction.
Area of Science:
- Cardiology
- Pharmacology
- Biochemistry
Background:
- The impact of sacubitril/valsartan (S/V) on natriuretic peptides in Asian heart failure (HF) cohorts is not well understood.
- Natriuretic peptides play a crucial role in cardiovascular homeostasis and HF management.
- Understanding treatment effects in diverse populations is essential for personalized medicine.
Purpose of the Study:
- To investigate the time-dependent changes in natriuretic peptide families during S/V treatment in Asian patients with compensated heart failure.
- To compare the effects of S/V with angiotensin-converting enzyme inhibitors (ACE-I) on natriuretic peptides and diuretic requirements.
- To identify factors associated with significant changes in atrial natriuretic peptide (ANP) levels.
Main Methods:
- Eighty-one outpatients with compensated HF were enrolled and divided into S/V (n=42) and ACE-I (n=39) groups.
- Changes in natriuretic peptide levels and daily loop diuretic doses were assessed at 3 and 6 months post-intervention.
- Multivariate logistic regression was used to analyze associations between clinical factors and ANP level changes.
Main Results:
- The S/V group showed a significant increase in atrial natriuretic peptide (ANP) levels at 3 and 6 months compared to baseline.
- Loop diuretic (furosemide) doses were significantly reduced in the S/V group over the 6-month follow-up.
- Persistent atrial fibrillation (AF) and HF with preserved left ventricular ejection fraction (HFpEF) were independently associated with a high ANP increase ratio in the S/V group.
Conclusions:
- Sacubitril/valsartan therapy increases plasma ANP levels and decreases loop diuretic requirements in patients with compensated HF.
- Neprilysin inhibitor therapy, such as S/V, shows efficacy in managing compensated HF, potentially by modulating natriuretic peptides.
- The increase in ANP during neprilysin inhibition is particularly notable in patients with HFpEF and persistent AF.
Abstract:
The time-dependent changes in the natriuretic peptide families during sacubitril/valsartan (S/V) treatment remain obscure in the Asian heart failure (HF) cohort. Eighty-one outpatients with compensated HF were analyzed. The patients were divided into two groups based on the administration of S/V (n = 42) or angiotensin converting enzyme inhibitor (ACE-I; n = 39). Changes to the natriuretic peptide families and the daily dose of loop diuretics were evaluated 3 and 6 months after the intervention. The atrial natriuretic peptide (ANP) level was significantly increased (102 [63-160] pg/mL to 283 [171-614] pg/mL [3 months]; 409 [210-726] pg/mL [6 months]) in the S/V group but not in the ACE-I group. The dose of furosemide was significantly decreased during the six-month follow-up period in the S/V group (40 [20-40] mg to 20 [10-20] mg) but not in the ACE-I group. A multivariate logistic regression model showed that the presence of persistent atrial fibrillation (AF) and HF with a preserved left ventricular ejection fraction (HFpEF) was independently associated with a high delta-ANP ratio (≥ 4.5 ANP value on the start date/ANP value at 6 months; the mean value was used as the cutoff value) (odds ratio [OR]: 4.649, 95% CI 1.032-20.952 and OR: 7.558, 95% CI 1.427-40.042). The plasma level of ANP was increased, and the loop diuretic dose was decreased by the addition of neprilysin inhibitor therapy in patients with compensated HF. In patients with HFpEF and complicated persistent AF, neprilysin inhibitor therapy was associated with an increase in ANP.
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