Impact of Sacubitril/Valsartan on Cardiac Autonomic Function Assessed Using Physiological Data from Implantable...

Area of Science:

• Cardiology
• Biomedical Engineering
• Physiology

Background:

• Sacubitril/Valsartan is a key treatment for heart failure with reduced ejection fraction (HFrEF).
• Assessing its impact on cardiac autonomic balance is crucial for understanding treatment efficacy.
• Implantable cardioverter-defibrillators (ICDs) and CRT-Ds offer continuous physiological data for such assessments.

Purpose of the Study:

• To evaluate the effect of Sacubitril/Valsartan on cardiac autonomic balance.
• To analyze changes in heart rate variability (HRV), 24-hour mean heart rate (24h-HR), and nocturnal heart rate (nHR).
• To correlate these changes with data from ICDs/CRT-Ds in HFrEF patients.

Main Methods:

• Observational study of 54 HFrEF patients initiating Sacubitril/Valsartan.
• Utilized remote monitoring data from ICDs/CRT-Ds.
• Collected data on HRV, 24h-HR, nHR, device electrical parameters, and ventricular arrhythmias at baseline, 3 months, and 12 months.

Main Results:

• Sacubitril/Valsartan significantly increased HRV (p=0.041) and reduced 24h-HR (p=0.016) and nHR (p=0.028) at 3 months.
• No significant changes were noted between 3 and 12 months.
• Ventricular arrhythmia burden decreased significantly in patients with pre-treatment arrhythmias (p=0.008).

Conclusions:

• Sacubitril/Valsartan therapy positively impacts cardiac autonomic indices in HFrEF patients.
• Improvements in HRV and reductions in heart rate were observed primarily within the first three months.
• The therapy demonstrated a favorable effect on cardiac autonomic regulation without adverse effects on device parameters.