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Effect of Sacubitril/Valsartan on Patients Having Heart Failure With Preserved Left Ventricular Ejection Fraction
Akira Mima1, Hidemasa Gotoda2, Shinji Lee2
1Department of Nephrology, Osaka Medical and Pharmaceutical University, Osaka, Japan; akira.mima@ompu.ac.jp.
Insights
Sacubitril/valsartan (SV) showed a trend towards lowering blood pressure and heart rate in heart failure patients on hemodialysis. However, long-term SV therapy did not significantly improve cardiac function markers like BNP or LVEF in this population.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Sacubitril/valsartan (SV) is a novel drug class targeting the neprilysin pathway and renin-angiotensin-aldosterone system.
- SV is effective in heart failure (HF) management, but its long-term effects in patients with preserved ejection fraction on hemodialysis (HD) are unknown.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of Sacubitril/valsartan (SV) in patients with HF and preserved left ventricular ejection fraction (LVEF) undergoing hemodialysis (HD).
Main Methods:
- A single-center retrospective study over 21 months.
- Included consecutive patients with HF and preserved LVEF on HD, treated with SV (50-200 mg/day).
- Clinical, biochemical, and echocardiographic parameters were assessed at baseline and during follow-up.
Main Results:
- Nine patients (median age 76 years, median HD duration 7 years) were included.
- SV therapy showed a non-significant trend towards decreasing systolic and diastolic blood pressure and heart rate.
- No significant changes were observed in brain natriuretic peptide (BNP) levels, LVEF, left atrial dimension, or left ventricular mass index.
Conclusions:
- Sacubitril/valsartan (SV) may help reduce blood pressure and heart rate in HF patients with preserved LVEF on hemodialysis.
- SV did not demonstrate significant improvements in cardiac function markers (BNP, echocardiography) in this specific patient group.
- No adverse effects were reported during the study period, suggesting a favorable safety profile.
Background/Aim:
Sacubitril/valsartan (SV), a novel pharmacological class of angiotensin receptor neprilysin inhibitors, is effective in treating heart failure (HF) by inhibiting the degradation of natriuretic peptides and the renin-angiotensin-aldosterone system. However, no studies have observed the long-term effects of SV on patients with HF and preserved left ventricular ejection fraction (LVEF) undergoing hemodialysis (HD) over a long period.
Patients And Methods:
This single-center retrospective study of 21 months duration involved consecutive patients with HF and preserved LVEF undergoing HD, who received 50-200 mg/day. All patients were followed up regularly, and clinical, biochemical, and echocardiographic parameters were recorded at baseline and during follow-up. The efficacy and safety of SV were also analyzed.
Results:
This longitudinal study included nine patients, with a median age of 76 years. The median HD duration was 7 years. At baseline, the mean brain natriuretic peptide (BNP) was 133±73.6 pg/ml and that of LVEF was 66%±9%. After SV therapy, the systolic blood pressure, diastolic blood pressure, and heart rate decreased, albeit without statistical significance. BNP levels, LVEF, left atrial anteroposterior dimension, and left ventricular mass index did not change, compared to baseline values. No adverse effects were observed in any of the patients.
Conclusion:
SV tended to decrease blood pressure and heart rate in patients with HF and preserved LVEF undergoing HD but did not alter cardiac function assessments, such as BNP or echocardiography.
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