Impact of Sacubitril/Valsartan on Cardiac Reverse Remodeling in Patients with Heart Failure Undergoing Cardiac
Tariel Atabekov1, Irina Silivanova1, Irina Kisteneva1
1Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya St., 111a, 634012 Tomsk, Russia.
Insights
Sacubitril/valsartan improved cardiac resynchronization therapy (CRT) response in heart failure patients. This drug enhanced reverse remodeling and electrical resynchronization, suggesting a synergistic role in optimizing CRT outcomes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Many heart failure (HF) patients have suboptimal responses to cardiac resynchronization therapy (CRT).
- Sacubitril/valsartan is known to beneficially impact cardiac remodeling.
Purpose of the Study:
- To investigate if sacubitril/valsartan improves outcomes in HF patients undergoing CRT implantation.
- To assess the impact of sacubitril/valsartan on CRT response and cardiac remodeling.
Main Methods:
- Single-center, observational study of 90 HF patients receiving CRT-defibrillators.
- Patients were stratified into sacubitril/valsartan (n=39) and control (n=51) groups.
- Primary endpoint: CRT response at 12 months (NYHA class, reverse remodeling, HF hospitalization freedom).
Main Results:
- The sacubitril/valsartan group showed a significantly higher CRT response rate (87.2% vs. 64.7%, p=0.016).
- Greater improvements were observed in the 6-minute walk test, NYHA class, LVESV reduction, and QRS duration in the sacubitril/valsartan group.
- Sacubitril/valsartan was an independent predictor of CRT response (OR=4.43, p=0.015).
Conclusions:
- Sacubitril/valsartan was independently associated with superior reverse remodeling, enhanced electrical resynchronization, and higher CRT response rates.
- Findings suggest a potential synergistic role for sacubitril/valsartan in optimizing post-CRT outcomes.
- Results are hypothesis-generating and require validation in larger randomized controlled trials.
Abstract:
Background/Objectives: Many heart failure (HF) patients exhibit a suboptimal response to cardiac resynchronization therapy (CRT). This study investigated whether sacubitril/valsartan, a drug known to beneficially impact cardiac remodeling, could improve outcomes for patients undergoing CRT implantation. Methods: In this single-center, observational study, 90 HF patients (left ventricular ejection fraction [LVEF] ≤ 35%) receiving a CRT-defibrillator were stratified into a sacubitril/valsartan group (n = 39) and a control group (n = 51). The primary endpoint was a CRT response at 12 months, defined as improvement in New York Heart Association (NYHA) class, left ventricular reverse remodeling (≥15% reduction in left ventricular end-systolic volume [LVESV] or ≥5% improvement in LVEF), and freedom from HF hospitalization. Results: The sacubitril/valsartan group had a significantly higher CRT response rate (87.2% vs. 64.7%, p = 0.016). They also showed greater improvement in the 6 min walk test (p = 0.013), NYHA class (p = 0.017), reduction in LVESV (p = 0.025), and QRS duration (p = 0.005). Multivariable analysis confirmed sacubitril/valsartan as an independent predictor of CRT response (OR = 4.43; 95% CI: 1.33-14.71; p = 0.015). Conclusions: In this study of HF patients receiving CRT, sacubitril/valsartan was independently associated with superior reverse remodeling, enhanced electrical resynchronization, and a higher rate of CRT response. These findings suggest a potential synergistic role for sacubitril/valsartan in optimizing post-CRT outcomes; however, as this was an observational study, they should be considered hypothesis-generating and require validation in larger, randomized controlled trials.
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