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Related Concept Videos

Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Mitral Regurgitation IV: Nursing Management01:28

Mitral Regurgitation IV: Nursing Management

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Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
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Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Related Experiment Video

Updated: Sep 9, 2025

Reduction in Left Ventricular Wall Stress and Improvement in Function in Failing Hearts using Algisyl-LVR
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Optimal Maintenance Strategy for Patients with Improved Left Ventricular Function Following Sacubitril/Valsartan

Yoonjee Park1, Minjung Bak2,3, Heayoung Shin2

  • 1Department of Cardiology, Bucheon Sejong Hospital, 28, Bucheon-si 14754, Republic of Korea.

Medicina (Kaunas, Lithuania)
|August 28, 2025
PubMed
Summary

Maintaining sacubitril/valsartan (S/V) or switching to a renin-angiotensin system blocker (RASB) is crucial for patients with heart failure with improved ejection fraction (HFimpEF). Discontinuing both therapies significantly increases the risk of heart failure relapse.

Keywords:
N-terminal-pro hormone B-type natriuretic peptideejection fractionheart failuresacubitril/valsartan

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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Optimal pharmacological management after left ventricular ejection fraction (LVEF) improvement in heart failure (HF) is not well-established.
  • Patients with HF and improved EF (HFimpEF) represent a growing population requiring specific treatment strategies.

Purpose of the Study:

  • To compare clinical outcomes in HFimpEF patients based on maintaining sacubitril/valsartan (S/V) versus switching to a renin-angiotensin system blocker (RASB).
  • To evaluate the impact of discontinuing S/V and RASB on HF relapse in this patient cohort.

Main Methods:

  • Retrospective analysis of 354 patients with recovered LVEF (≥40%) after S/V treatment.
  • Patients were grouped into: continued S/V (n=294), switched to RASB (n=47), or discontinued both (n=13).
  • Primary endpoint: HF relapse (2-fold NT-proBNP increase >400 pg/dL); Secondary endpoints: NT-proBNP level changes.

Main Results:

  • No significant difference in HF relapse or NT-proBNP levels between S/V maintenance and RASB switch groups.
  • Discontinuation of both S/V and RASB was associated with a significantly higher HF relapse rate (53.8%) compared to maintenance groups (10.6%-16.3%; p=0.001).
  • NT-proBNP levels showed a more pronounced increase in the group that discontinued both therapies.

Conclusions:

  • Replacing S/V with another RASB is a safe strategy for maintaining remission in HFimpEF patients.
  • Discontinuing all guideline-directed medical therapy in HFimpEF significantly elevates the risk of relapse.
  • Prospective studies are needed to confirm these findings and optimize long-term management.