Long-Term Effects of Sacubitril-Valsartan on Cardiac Remodeling: A Parallel Echocardiographic Study of Left and Right
Federica Valli1, Francesca Bursi2,3, Gloria Santangelo2
1Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Insights
Sacubitril/Valsartan (S/V) shows potential for long-term reverse remodeling in heart failure patients. Early treatment may enhance these beneficial effects, particularly for the right ventricle.
Area of Science:
- Cardiology
- Pharmacology
- Heart Failure Management
Background:
- Sacubitril/Valsartan (S/V) is known for potential anti-remodeling effects.
- Long-term outcomes and biventricular responses to S/V require further elucidation.
- Heart failure with reduced ejection fraction (HFrEF) necessitates understanding adaptive cardiac responses.
Purpose of the Study:
- To evaluate the long-term anti-remodeling effects of Sacubitril/Valsartan (S/V) in HFrEF patients.
- To assess the biventricular adaptive response to progressive S/V uptitration.
- To identify predictors of left ventricular reverse remodeling (LVRR).
Main Methods:
- Prospective study of 76 HFrEF patients undergoing progressive S/V uptitration.
- Median follow-up of 11 months with annual assessments.
- Defined LVRR by significant improvements in LV ejection fraction and LV end-diastolic diameter; assessed right ventricular (RV) function using TAPSE and TAPSE/PASP.
Main Results:
- Left ventricular reverse remodeling (LVRR) observed in 27.6% of patients.
- Non-ischemic etiology, shorter HF duration, and absence of atrial fibrillation predicted LVRR.
- Significant improvements in RV function (TAPSE and TAPSE/PASP) and RV remodeling occurred, even in patients with baseline RV dysfunction.
Conclusions:
- Sacubitril/Valsartan (S/V) demonstrates a potential for long-term global reverse remodeling in HFrEF.
- Early initiation of S/V may be particularly beneficial for achieving reverse remodeling.
- S/V may exert a direct beneficial effect on RV-pulmonary circulation hemodynamics.
Abstract:
Sacubitril/Valsartan (S/V) carries potential anti-remodeling properties, however long-term effects and biventricular adaptive response are poorly described. 76 HFrEF patients who underwent progressive uptitration of S/V, completed the annual scheduled follow-up. After a median follow-up of 11 (8-13) months, left ventricular (LV) reverse remodeling (RR) is defined as (1) absolute increase in LV ejection fraction (EF) ≥ 10% or LVEF ≥ 50% at follow-up and (2) decrease in indexed LV end-diastolic diameter (LVEDDi) of at least 10% or indexed LVEDDi ≤ 33 mm/m2, occurred in 27.6%. Non-ischemic etiology, shorter duration of HF, and absence of a history of AF were independently associated with LVRR (p < 0.05). TAPSE and TAPSE/PASP, a non-invasive index of right ventricular (RV) coupling to the pulmonary circulation, significantly improved at follow-up (0.45 vs. 0.56, p = 0.02). 41% of patients with baseline RV dysfunction obtained favorable RV remodeling despite only a moderate correlation between RV and LV function was observed (r = 0.478, p = 0.002). Our data point to a potential long-term reverse global remodeling effect by S/V, especially in patients who start S/V at an early stage of the disease, and focus our attention on a possible direct effect of the drug in synergistic hemodynamics between RV and pulmonary circulation.
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