Reverse Remodeling Effects of Sacubitril-Valsartan: Structural and Functional Optimization in Stage C Heart Failure.
Citation: American Journal of Cardiology. 210:249-255, 2024 Jan 01.PMID: 37884115Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Heart Failure | *Ventricular Dysfunction, Left | Adult | Aged | Aminobutyrates/pd [Pharmacology] | Aminobutyrates/tu [Therapeutic Use] | Angiotensin Receptor Antagonists/pd [Pharmacology] | Angiotensin Receptor Antagonists/tu [Therapeutic Use] | Drug Combinations | Female | Heart Failure/dg [Diagnostic Imaging] | Heart Failure/dt [Drug Therapy] | Humans | Longitudinal Studies | Male | Middle Aged | Prospective Studies | Stroke Volume | Tetrazoles/tu [Therapeutic Use] | Treatment Outcome | Valsartan/pd [Pharmacology] | Ventricular Function, LeftYear: 2024ISSN:- 0002-9149
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 37884115 | Available | 37884115 |
Sacubitril-valsartan, an angiotensin receptor-neprilysin inhibitor, reduces all-cause mortality and the rate of heart failure hospitalizations in patients with heart failure with reduced ejection fraction. This study aimed to elucidate the benefits of initiating sacubitril-valsartan on ventricular remodeling in patients previously optimized on guideline-directed medical therapy. In this prospective, single-arm longitudinal study, 40 patients with heart failure with reduced ejection fraction who were optimized on guideline-directed medical therapy were transitioned to sacubitril-valsartan. The primary end point was the change in left ventricular (LV) volume at 1 year as assessed by 3-dimensional transthoracic echocardiography. Other echocardiographic end points included change in LV-function and change in right ventricular (RV) size and function. The mean age was 55 +/- 12 years, and 63% were male. At 1 year, LV end-diastolic volume decreased from 242 +/- 71 to 157 +/- 57 ml (p <0.001) with a corresponding increase in LV ejection fraction from 32 +/- 7% to 44 +/- 9% (p <0.001). RV end-diastolic volume decreased from 151 +/- 51 to 105 +/-45 ml (p <0.001). Although RV ejection fraction did not change (51 +/- 8 vs 51 +/- 10; p = 0.35), RV global longitudinal strain improved from -14.9 +/- 3.4 % to -19.3 +/- 4.3% (p <0.001). When added to standard medical therapy for heart failure, sacubitril-valsartan induces significant remodeling of both the right and left ventricles as assessed by 3-dimensional echocardiography. Copyright © 2023 Elsevier Inc. All rights reserved.
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