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The reverse remodeling response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction
| Content Provider | Scilit |
|---|---|
| Author | Martens, Pieter Beliën, Hanne Dupont, Matthias Vandervoort, Pieter Mullens, Wilfried |
| Copyright Year | 2018 |
| Description | Journal: Cardiovascular Therapeutics Background Major classes of medical therapy for heart failure with reduced ejection fraction (HFrEF) induce reverse remodeling. The revere remodeling response to sacubitril/valsartan remains unstudied. Methods We performed a single‐center, prospective assessor‐blinded study to determine the reverse remodeling response of sacubitril/valsartan‐therapy in HFrEF‐patients with a class I‐indication (New York heart Association [NYHA]‐class II‐IV, Left ventricular ejection fraction [LVEF]<35%, optimal dose with Renin‐Angiotensin‐System‐Blocker [RAS‐blocker]). Doses of sacubitril/valsartan were optimized to individual tolerance. Echocardiographic images were assessed offline by two investigators blinded to both the clinical data and timing of echocardiograms. Results One‐hundred‐twenty‐five HFrEF‐patients (66±10years) were prospectively included. The amount of RAS‐blocker before and after switch to sacubitril/valsartan was similar(p=0.290), indicating individual optimal dosing of sacubitril/valsartan. Over a median(IQR) follow‐up of 118(77–160) days after initiation of sacubitril/valsartan, LVEF improved (29.6±6% vs. 34.8±6%;p<0.001) and Left ventricular end‐systolic (LVESV) and end‐diastolic volume (LVEDV) decreased (LVESV;147±57ml vs.129±55ml;p<0.001 and LVEDV; 206±71ml vs.197±72ml;p=0.027). Volumetric remodeling was associated with a reduction in the degree of mitral regurgitation (1.59±1.0 vs.1.11±0.8;p<0.001;[scale from 0‐4]). Metrics of diastolic function improved; including a drop in the E/A‐wave ratio (1.75±1.13vs. 1.38±0.88;p=0.002) and diastolic‐filling time (% of cycle‐length) prolonged (48±9%vs. 52±1%;p=0.005). The percent of patients with a restrictive mitral filling pattern dropped from 47% to 23%(p=0.004). A dose‐dependent effect was noted for changes in LVEF (p<0.001) and LVESV (p=0.031), with higher doses of sacubitril/valsartan leading to more reverse remodeling. Conclusion Switching therapy in eligible HFrEF‐patients from a RAS‐blocker to sacubitril/valsartan induces beneficial reverse remodeling of both metrics of systolic as diastolic function. This article is protected by copyright. All rights reserved. |
| ISSN | 2573508X |
| e-ISSN | 17555922 |
| DOI | 10.1111/1755-5922.12435 |
| Journal | Cardiovascular Therapeutics |
| Issue Number | 4 |
| Volume Number | 36 |
| Language | English |
| Publisher | Wiley-Blackwell |
| Publisher Date | 2018-08-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Cardiovascular Therapeutics Cardiology and Cardiovascular Diseases Sacubitril/valsartan Reverse Remodeling Left Ventricular Ejection Fraction |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pharmacology Pharmacology (medical) Cardiology and Cardiovascular Medicine |
