Related Experiment Video
Updated: May 26, 2025
Simplified Intrafemoral Injections Using Live Mice Allow for Continuous Bone Marrow Analysis
Published on: November 10, 2023
Effect of Sacubitril/Valsartan or Enalapril on Left Ventricular Function in Patients With Hematologic Malignancies
Konstantinos Katogiannis1, Ignatios Ikonomidis1, Dimitrios Farmakis1
12nd Cardiology Department, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece.
Background:
In patients with bone marrow transplantation (BMT) for hematologic malignancies, evidence for prevention of cancer therapy-related cardiac dysfunction (CTRCD) remains limited.
Objectives:
The authors investigated whether early initiation of sacubitril/valsartan or enalapril could be helpful to prevent CTRCD in patients undergoing BMT.
Methods:
We randomized 90 patients with preserved left ventricular ejection fraction (LVEF) after BMT to sacubitril/valsartan, enalapril, or no cardioprotective medication (controls). The primary endpoints included i) LVEF, ii) LV global longitudinal strain (GLS), iii) myocardial wasted work (GWW), and work efficiency (GWE) by speckle tracking echocardiography. Secondary endpoints included changes in LV volumes.
Results:
Patients treated with sacubitril/valsartan or enalapril for 6 months did not show a deterioration of LV GLS or LVEF (P > 0.05). Conversely, controls showed impaired LV GLS (-20.9% ± 2.1% vs -18.8% ± 2.6%, P = 0.001) and reduced LVEF (P = 0.045) at 6 months post-BMT. The percent improvement of GWW and GWE was greater in the sacubitril/valsartan compared to enalapril or control group (P = 0.044 and P = 0.011, respectively) at 6 months. Conversely, in controls, GWW increased (80.7 ± 60.6 vs 115.3 ± 52.1 mm Hg%, P = 0.045), and GWE was compromised (P = 0.030) at 6 months post-BMT. Among the 3 treatment groups, only sacubitril/valsartan group showed a reduction in LV end-diastolic and systolic volume compared to baseline (102.3 ± 26.9 vs 93.2 ± 18.9 mL, P = 0.042 and 44.5 ± 15.4 vs 39.1 ± 10.1 mL, P = 0.012, respectively).
Conclusions:
Treatment with sacubitril/valsartan or enalapril prevented deterioration of myocardial function at 6 months in patients with hematologic malignancies treated with BMT. Moreover, sacubitril/valsartan showed a more favorable effect on myocardial work indices. (Effect of Angiotensin Converting Enzyme and Sacubitril Valsartan in Patients After Bone Marrow Transplantation; NCT04092309).
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...
01:22Heart Failure Drugs: Diuretics
01:22Heart Failure Drugs: β-Blockers